- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $40.74 / $131.83
| Professional | | $25.12 | $40.74 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $10.72 / $33.11
| Professional | 26 | $6.61 | $10.72 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $21.88 / $37.15
| Professional | TC | $16.60 | $21.88 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $39.81 / $39.81
| Professional | | $10.96 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $10.96 / $13.18
| Facility | 26 | $10.96 | $10.96 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $61.66
| Professional | | $32.36 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $10.23 / $16.60
| Professional | 26 | $8.32 | $10.23 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $33.11 / $51.29
| Professional | TC | $23.99 | $33.11 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $43.65 / $47.86
| Professional | | $42.66 | $43.65 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $10.96 / $13.18
| Facility | 26 | $10.96 | $10.96 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.71 / $61.66
| Professional | | $34.67 | $45.71 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.23 / $15.49
| Professional | 26 | $7.94 | $10.23 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $28.18 / $40.74
| Professional | TC | $23.99 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $44.67 / $53.70
| Professional | | $35.48 | $44.67 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $12.30 / $14.45
| Professional | 26 | $9.33 | $12.30 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $31.62 / $38.90
| Professional | TC | $25.12 | $31.62 | $38.90 |