- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.76 / $30.03 / $31.36
| Professional | | $25.76 | $30.03 | $31.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.48 / $9.81 / $10.18
| Professional | 26 | $8.48 | $9.81 | $10.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.28 / $19.85 / $21.54
| Professional | TC | $17.28 | $19.85 | $21.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $62.59 / $62.59 / $62.59
| Facility | 26 | $62.59 | $62.59 | $62.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.02 / $47.18 / $133.13
| Professional | | $40.02 | $47.18 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.81 / $14.81 / $14.81
| Professional | 26 | $14.81 | $14.81 | $14.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.06 / $26.06 / $26.06
| Professional | TC | $26.06 | $26.06 | $26.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $46.65 / $133.13
| Professional | | $38.54 | $46.65 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.56 / $15.04 / $40.86
| Professional | 26 | $13.56 | $15.04 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.73 / $31.89 / $49.93
| Professional | TC | $23.73 | $31.89 | $49.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $45.86 / $133.13
| Professional | | $38.54 | $45.86 | $133.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.56 / $15.04 / $40.86
| Professional | 26 | $13.56 | $15.04 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.48 / $26.94 / $49.93
| Professional | TC | $23.48 | $26.94 | $49.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.21 / $53.40 / $141.62
| Professional | | $25.21 | $53.40 | $141.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $15.01 / $38.78
| Professional | 26 | $9.94 | $15.01 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.25 / $33.42 / $98.15
| Professional | TC | $17.25 | $33.42 | $98.15 |