- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.49 / $59.60 / $62.04
| Professional | | $51.49 | $59.60 | $62.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.36 / $16.52 / $17.07
| Professional | 26 | $14.36 | $16.52 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.11 / $42.53 / $46.79
| Professional | TC | $37.11 | $42.53 | $46.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.16 / $80.34 / $264.02
| Professional | | $68.16 | $80.34 | $264.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.01 / $19.01 / $63.16
| Professional | 26 | $19.01 | $19.01 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.64 / $48.64 / $57.68
| Professional | TC | $48.64 | $48.64 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.95 / $90.57 / $264.02
| Professional | | $73.95 | $90.57 | $264.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.31 / $22.08 / $63.16
| Professional | 26 | $21.31 | $22.08 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.65 / $63.81 / $102.01
| Professional | TC | $52.65 | $63.81 | $102.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.95 / $89.64 / $264.02
| Professional | | $73.95 | $89.64 | $264.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.31 / $22.08 / $63.16
| Professional | 26 | $21.31 | $22.08 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.65 / $58.56 / $97.77
| Professional | TC | $52.65 | $58.56 | $97.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.15 / $84.37 / $280.85
| Professional | | $57.15 | $84.37 | $280.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.45 / $24.41 / $67.19
| Professional | 26 | $16.45 | $24.41 | $67.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.48 / $61.36 / $213.66
| Professional | TC | $41.48 | $61.36 | $213.66 |