- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.63 / $68.04 / $86.20
| Professional | | $27.63 | $68.04 | $86.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $10.31 / $12.04
| Professional | 26 | $8.83 | $10.31 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.04 / $58.74 / $74.16
| Professional | TC | $16.04 | $58.74 | $74.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.43 / $60.43 / $60.43
| Facility | 26 | $60.43 | $60.43 | $60.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $38.47 / $101.70
| Professional | | $31.35 | $38.47 | $101.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.03 / $12.03 / $39.47
| Professional | 26 | $12.03 | $12.03 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.97 / $17.97 / $21.18
| Professional | TC | $17.97 | $17.97 | $21.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.66 / $51.89 / $113.08
| Professional | | $31.66 | $51.89 | $113.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.26 / $13.95 / $39.47
| Professional | 26 | $13.26 | $13.95 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.05 / $25.45 / $123.63
| Professional | TC | $18.05 | $25.45 | $123.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.66 / $51.89 / $113.08
| Professional | | $31.66 | $51.89 | $113.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.26 / $13.59 / $39.47
| Professional | 26 | $13.26 | $13.59 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.05 / $23.78 / $96.72
| Professional | TC | $18.05 | $23.78 | $96.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.46 / $55.54 / $164.05
| Professional | | $23.46 | $55.54 | $164.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.09 / $14.34 / $41.99
| Professional | 26 | $10.09 | $14.34 | $41.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.35 / $33.97 / $150.36
| Professional | TC | $13.35 | $33.97 | $150.36 |