- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.09 / $40.74 / $43.08
| Professional | | $35.09 | $40.74 | $43.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.82 / $13.60 / $14.06
| Professional | 26 | $11.82 | $13.60 | $14.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.26 / $26.68 / $30.27
| Professional | TC | $23.26 | $26.68 | $30.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.53 / $56.03 / $181.74
| Professional | | $47.53 | $56.03 | $181.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.95 / $18.80 / $52.33
| Professional | 26 | $15.95 | $18.80 | $52.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.72 / $31.72 / $31.72
| Professional | TC | $31.72 | $31.72 | $31.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.52 / $62.85 / $181.74
| Professional | | $50.52 | $62.85 | $181.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.52 / $18.35 / $52.33
| Professional | 26 | $17.52 | $18.35 | $52.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.99 / $39.99 / $63.91
| Professional | TC | $32.99 | $39.99 | $63.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.52 / $61.23 / $181.74
| Professional | | $50.52 | $61.23 | $181.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.52 / $18.35 / $52.33
| Professional | 26 | $17.52 | $18.35 | $52.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.99 / $36.83 / $63.72
| Professional | TC | $32.99 | $36.83 | $63.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.02 / $61.86 / $193.32
| Professional | | $43.02 | $61.86 | $193.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.55 / $20.16 / $55.67
| Professional | 26 | $13.55 | $20.16 | $55.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.08 / $38.44 / $137.65
| Professional | TC | $27.08 | $38.44 | $137.65 |