- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.35 / $66.43 / $315.02
| Professional | | $26.35 | $66.43 | $315.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.17 / $25.45 / $137.96
| Professional | 26 | $17.17 | $25.45 | $137.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.18 / $11.47 / $113.00
| Professional | TC | $9.18 | $11.47 | $113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.81 / $68.95 / $177.13
| Professional | | $57.81 | $68.95 | $177.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $35.61 / $137.74
| Professional | 26 | $24.71 | $35.61 | $137.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.72 / $39.22 / $39.22
| Professional | TC | $33.72 | $39.22 | $39.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.70 / $79.22 / $177.13
| Professional | | $42.70 | $79.22 | $177.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.44 / $39.45 / $137.74
| Professional | 26 | $25.44 | $39.45 | $137.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.80 / $44.54 / $74.26
| Professional | TC | $13.80 | $44.54 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.04 / $79.22 / $177.13
| Professional | | $41.04 | $79.22 | $177.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.24 / $33.90 / $137.74
| Professional | 26 | $27.24 | $33.90 | $137.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.80 / $36.08 / $74.26
| Professional | TC | $13.80 | $36.08 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.13 / $58.43 / $96.74
| Professional | | $36.13 | $58.43 | $96.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.38 / $31.72 / $146.52
| Professional | 26 | $23.38 | $31.72 | $146.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.41 / $33.20 / $42.88
| Professional | TC | $11.41 | $33.20 | $42.88 |