- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.19 / $35.61 / $37.29
| Professional | | $30.19 | $35.61 | $37.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.31 / $11.90 / $12.37
| Professional | 26 | $10.31 | $11.90 | $12.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.89 / $23.24 / $25.88
| Professional | TC | $19.89 | $23.24 | $25.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.56 / $53.71 / $157.44
| Professional | | $45.56 | $53.71 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.21 / $16.75 / $46.62
| Professional | 26 | $14.21 | $16.75 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.89 / $29.89 / $35.24
| Professional | TC | $29.89 | $29.89 | $35.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.71 / $54.02 / $157.44
| Professional | | $43.71 | $54.02 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.39 / $16.21 / $46.62
| Professional | 26 | $15.39 | $16.21 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.31 / $32.03 / $54.84
| Professional | TC | $28.31 | $32.03 | $54.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.71 / $52.98 / $157.44
| Professional | | $43.71 | $52.98 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.39 / $16.02 / $46.62
| Professional | 26 | $15.39 | $16.02 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.31 / $30.82 / $54.80
| Professional | TC | $28.31 | $30.82 | $54.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.45 / $50.92 / $136.38
| Professional | | $36.45 | $50.92 | $136.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.89 / $17.51 / $49.59
| Professional | 26 | $11.89 | $17.51 | $49.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.31 / $32.99 / $117.90
| Professional | TC | $23.31 | $32.99 | $117.90 |