- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $54.95 / $123.03
| Professional | | $26.92 | $54.95 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $21.38 / $40.74
| Professional | 26 | $10.00 | $21.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $30.90 / $89.13
| Professional | TC | $18.20 | $30.90 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $45.71 / $158.49
| Professional | | $45.71 | $45.71 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $46.77
| Professional | 26 | $14.13 | $14.13 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $30.20 / $35.48
| Professional | TC | $30.20 | $30.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $52.48 / $112.20
| Professional | | $43.65 | $52.48 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $16.22 / $34.67
| Professional | 26 | $15.14 | $16.22 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $32.36 / $75.86
| Professional | TC | $28.18 | $32.36 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $158.49
| Professional | | $33.88 | $33.88 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $11.75 / $46.77
| Professional | 26 | $11.75 | $11.75 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $21.88 / $21.88
| Professional | TC | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $50.12 / $125.89
| Professional | | $36.31 | $50.12 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $16.60 / $36.31
| Professional | 26 | $12.02 | $16.60 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $31.62 / $89.13
| Professional | TC | $23.44 | $31.62 | $89.13 |