- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.59 / $43.81 / $45.87
| Professional | | $37.59 | $43.81 | $45.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.08 / $16.57 / $16.80
| Professional | 26 | $14.08 | $16.57 | $16.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.51 / $27.00 / $29.29
| Professional | TC | $23.51 | $27.00 | $29.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.36 / $94.36 / $94.36
| Facility | 26 | $94.36 | $94.36 | $94.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.24 / $69.84 / $199.72
| Professional | | $59.24 | $69.84 | $199.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.00 / $24.75 / $68.87
| Professional | 26 | $21.00 | $24.75 | $68.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.47 / $36.47 / $43.00
| Professional | TC | $36.47 | $36.47 | $43.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.64 / $67.54 / $199.72
| Professional | | $50.64 | $67.54 | $199.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.23 / $23.66 / $68.87
| Professional | 26 | $20.23 | $23.66 | $68.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.90 / $37.88 / $64.53
| Professional | TC | $28.90 | $37.88 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.64 / $63.26 / $199.72
| Professional | | $50.64 | $63.26 | $199.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.69 / $23.66 / $68.87
| Professional | 26 | $20.69 | $23.66 | $68.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.90 / $35.72 / $64.53
| Professional | TC | $28.90 | $35.72 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.56 / $72.06 / $173.89
| Professional | | $46.56 | $72.06 | $173.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.80 / $24.39 / $73.26
| Professional | 26 | $16.80 | $24.39 | $73.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.88 / $40.53 / $108.56
| Professional | TC | $28.88 | $40.53 | $108.56 |