- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.13 / $45.27 / $74.64
| Professional | | $41.13 | $45.27 | $74.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.24 / $13.63 / $18.44
| Professional | 26 | $11.24 | $13.63 | $18.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.32 / $32.90 / $51.07
| Professional | TC | $28.32 | $32.90 | $51.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.84 / $59.54 / $76.28
| Professional | | $39.84 | $59.54 | $76.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.53 / $18.55 / $24.54
| Professional | 26 | $12.53 | $18.55 | $24.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.30 / $40.38 / $52.51
| Professional | TC | $27.30 | $40.38 | $52.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.76 / $71.30 / $86.04
| Professional | | $50.76 | $71.30 | $86.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.74 / $20.37 / $23.28
| Professional | 26 | $13.74 | $20.37 | $23.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $32.34 / $69.20
| Professional | | $19.60 | $32.34 | $69.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $513.03 / $513.03 / $513.03
| Facility | 26 | $513.03 | $513.03 | $513.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.24 / $63.76 / $66.17
| Professional | | $56.24 | $63.76 | $66.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.22 / $17.91 / $20.50
| Professional | 26 | $15.22 | $17.91 | $20.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.40 / $43.74 / $48.26
| Professional | TC | $39.40 | $43.74 | $48.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.70 / $57.50 / $77.04
| Professional | | $43.70 | $57.50 | $77.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.97 / $17.28 / $23.00
| Professional | 26 | $12.97 | $17.28 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.02 / $38.71 / $52.92
| Professional | TC | $30.02 | $38.71 | $52.92 |