- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.27 / $51.30 / $54.25
| Professional | | $44.27 | $51.30 | $54.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.41 / $15.43 / $15.94
| Professional | 26 | $13.41 | $15.43 | $15.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.85 / $35.36 / $39.71
| Professional | TC | $30.85 | $35.36 | $39.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.67 / $69.16 / $228.95
| Professional | | $58.67 | $69.16 | $228.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.14 / $18.14 / $59.52
| Professional | 26 | $18.14 | $18.14 | $59.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.44 / $40.44 / $48.95
| Professional | TC | $40.44 | $40.44 | $48.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.64 / $79.04 / $228.95
| Professional | | $63.64 | $79.04 | $228.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.89 / $20.61 / $59.52
| Professional | 26 | $19.89 | $20.61 | $59.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.76 / $53.04 / $84.78
| Professional | TC | $43.76 | $53.04 | $84.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.64 / $77.14 / $228.95
| Professional | | $63.64 | $77.14 | $228.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.89 / $20.61 / $59.52
| Professional | 26 | $19.89 | $20.61 | $59.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.76 / $48.19 / $83.99
| Professional | TC | $43.76 | $48.19 | $83.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.77 / $77.79 / $243.54
| Professional | | $53.77 | $77.79 | $243.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.37 / $22.09 / $56.40
| Professional | 26 | $15.37 | $22.09 | $56.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.65 / $50.98 / $180.22
| Professional | TC | $35.65 | $50.98 | $180.22 |