- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.14 / $58.31 / $58.60
| Professional | | $50.14 | $58.31 | $58.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.57 / $30.44 / $31.59
| Professional | 26 | $26.57 | $30.44 | $31.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.57 / $27.02 / $27.86
| Professional | TC | $23.57 | $27.02 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.22 / $65.11 / $223.49
| Professional | | $35.22 | $65.11 | $223.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.53 / $120.57 / $120.57
| Professional | 26 | $41.53 | $120.57 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.88 / $29.88 / $29.88
| Professional | TC | $29.88 | $29.88 | $29.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.02 / $76.45 / $223.49
| Professional | | $73.02 | $76.45 | $223.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.56 / $41.27 / $120.57
| Professional | 26 | $39.56 | $41.27 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.45 / $35.29 / $64.81
| Professional | TC | $33.45 | $35.29 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.02 / $76.45 / $223.49
| Professional | | $73.02 | $76.45 | $223.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.56 / $41.17 / $120.57
| Professional | 26 | $39.56 | $41.17 | $120.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.46 / $35.02 / $56.76
| Professional | TC | $33.46 | $35.02 | $56.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.62 / $80.77 / $209.06
| Professional | | $63.62 | $80.77 | $209.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.75 / $46.10 / $128.25
| Professional | 26 | $33.75 | $46.10 | $128.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.78 / $36.81 / $109.49
| Professional | TC | $27.78 | $36.81 | $109.49 |