- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $39.81 / $97.72
| Professional | | $32.36 | $39.81 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $28.18 / $69.18
| Professional | 26 | $20.89 | $28.18 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.00 / $12.59 / $25.12
| Professional | TC | $10.00 | $12.59 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $53.70 / $53.70
| Professional | | $33.88 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $33.88 / $40.74
| Facility | 26 | $33.88 | $33.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $45.71 / $120.23
| Professional | | $34.67 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $30.20 / $75.86
| Professional | 26 | $22.39 | $30.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $15.14 / $41.69
| Professional | TC | $11.75 | $15.14 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $57.54 / $66.07
| Professional | | $48.98 | $57.54 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $33.88 / $40.74
| Facility | 26 | $33.88 | $33.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $56.23 / $87.10
| Professional | | $36.31 | $56.23 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $30.90 / $47.86
| Professional | 26 | $21.38 | $30.90 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $15.85 / $24.55
| Professional | TC | $11.75 | $15.85 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $54.95 / $64.57
| Professional | | $42.66 | $54.95 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $38.02 / $44.67
| Professional | 26 | $28.18 | $38.02 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.80 / $17.78 / $20.89
| Professional | TC | $13.80 | $17.78 | $20.89 |