- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.22 / $41.57 / $43.77
| Professional | | $35.22 | $41.57 | $43.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.06 / $13.95 / $14.49
| Professional | 26 | $12.06 | $13.95 | $14.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.17 / $27.08 / $30.60
| Professional | TC | $23.17 | $27.08 | $30.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.18 / $62.69 / $183.18
| Professional | | $53.18 | $62.69 | $183.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.52 / $16.52 / $53.77
| Professional | 26 | $16.52 | $16.52 | $53.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.82 / $34.82 / $41.04
| Professional | TC | $34.82 | $34.82 | $41.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.99 / $62.36 / $183.18
| Professional | | $50.99 | $62.36 | $183.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.00 / $19.00 / $53.77
| Professional | 26 | $18.00 | $19.00 | $53.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.99 / $37.88 / $63.91
| Professional | TC | $32.99 | $37.88 | $63.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.99 / $61.81 / $183.18
| Professional | | $50.99 | $61.81 | $183.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.00 / $18.64 / $53.77
| Professional | 26 | $18.00 | $18.64 | $53.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.99 / $35.90 / $63.72
| Professional | TC | $32.99 | $35.90 | $63.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.11 / $59.42 / $194.85
| Professional | | $40.11 | $59.42 | $194.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.86 / $20.69 / $57.20
| Professional | 26 | $13.86 | $20.69 | $57.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.49 / $38.44 / $137.65
| Professional | TC | $25.49 | $38.44 | $137.65 |