- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.39 / $41.73 / $42.06
| Professional | | $35.39 | $41.73 | $42.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.53 / $14.32 / $15.03
| Professional | 26 | $12.53 | $14.32 | $15.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.85 / $26.70 / $27.56
| Professional | TC | $22.85 | $26.70 | $27.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.75 / $63.36 / $180.34
| Professional | | $53.75 | $63.36 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.41 / $21.69 / $55.21
| Professional | 26 | $18.41 | $21.69 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.86 / $36.86 / $36.86
| Professional | TC | $36.86 | $36.86 | $36.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $61.38 / $180.34
| Professional | | $51.23 | $61.38 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.70 / $19.70 / $55.21
| Professional | 26 | $18.70 | $19.70 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.52 / $36.61 / $63.00
| Professional | TC | $32.52 | $36.61 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $61.38 / $180.34
| Professional | | $51.23 | $61.38 | $180.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.70 / $19.35 / $55.21
| Professional | 26 | $18.70 | $19.35 | $55.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.52 / $35.35 / $62.09
| Professional | TC | $32.52 | $35.35 | $62.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.77 / $59.70 / $191.84
| Professional | | $39.77 | $59.70 | $191.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.24 / $20.77 / $58.73
| Professional | 26 | $14.24 | $20.77 | $58.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.40 / $37.90 / $133.11
| Professional | TC | $26.40 | $37.90 | $133.11 |