- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $97.72 / $245.47
| Professional | | $48.98 | $97.72 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $19.95 / $46.77
| Professional | 26 | $14.13 | $19.95 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.15 / $57.54 / $194.98
| Professional | TC | $37.15 | $57.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $91.20 / $302.00
| Professional | | $77.62 | $91.20 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $19.05 / $63.10
| Professional | 26 | $19.05 | $19.05 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.54 / $57.54 / $69.18
| Professional | TC | $57.54 | $57.54 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $97.72 / $213.80
| Professional | | $81.28 | $97.72 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $22.39 / $47.86
| Professional | 26 | $18.62 | $22.39 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $72.44 / $169.82
| Professional | TC | $60.26 | $72.44 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $302.00
| Professional | | $63.10 | $63.10 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $16.22 / $63.10
| Professional | 26 | $16.22 | $16.22 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | TC | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $93.33 / $245.47
| Professional | | $69.18 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $22.91 / $51.29
| Professional | 26 | $16.60 | $22.91 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $67.61 / $190.55
| Professional | TC | $48.98 | $67.61 | $190.55 |