- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $25.70 / $47.86
| Professional | | $20.89 | $25.70 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $20.89 / $26.92
| Professional | 26 | $18.20 | $20.89 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.02 / $3.98 / $8.91
| Professional | TC | $3.02 | $3.98 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $32.36 / $56.23
| Professional | | $20.89 | $32.36 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $25.70 / $42.66
| Professional | 26 | $17.38 | $25.70 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.09 / $5.75 / $19.05
| Professional | TC | $3.09 | $5.75 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $35.48 / $77.62
| Professional | | $22.91 | $35.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $25.12 / $46.77
| Professional | 26 | $18.20 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.09 / $5.75 / $33.88
| Professional | TC | $3.09 | $5.75 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | 26 | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $323.59
| Professional | | $302.00 | $302.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $158.49 / $165.96 / $165.96
| Professional | 26 | $158.49 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $186.21 / $186.21 / $223.87
| Professional | TC | $186.21 | $186.21 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $25.70 / $54.95
| Professional | | $19.50 | $25.70 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $19.95 / $29.51
| Professional | 26 | $15.85 | $19.95 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.09 / $4.17 / $30.20
| Professional | TC | $3.09 | $4.17 | $30.20 |