- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.17 / $29.17 / $29.53
| Professional | | $25.17 | $29.17 | $29.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.50 / $8.52 / $8.91
| Professional | 26 | $7.50 | $8.52 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.67 / $20.26 / $20.90
| Professional | TC | $17.67 | $20.26 | $20.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.36 / $39.32 / $124.54
| Professional | | $33.36 | $39.32 | $124.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.19 / $12.02 / $33.72
| Professional | 26 | $10.19 | $12.02 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.17 / $23.17 / $27.32
| Professional | TC | $23.17 | $23.17 | $27.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $43.21 / $124.54
| Professional | | $36.15 | $43.21 | $124.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.13 / $11.58 / $33.72
| Professional | 26 | $11.13 | $11.58 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.04 / $30.35 / $48.49
| Professional | TC | $25.04 | $30.35 | $48.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $43.21 / $124.54
| Professional | | $36.15 | $43.21 | $124.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.13 / $11.58 / $33.72
| Professional | 26 | $11.13 | $11.58 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.04 / $27.45 / $46.69
| Professional | TC | $25.04 | $27.45 | $46.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.11 / $42.15 / $132.47
| Professional | | $28.11 | $42.15 | $132.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.60 / $12.73 / $35.86
| Professional | 26 | $8.60 | $12.73 | $35.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.93 / $29.33 / $78.56
| Professional | TC | $20.93 | $29.33 | $78.56 |