- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.24 / $57.83 / $60.01
| Professional | | $51.24 | $57.83 | $60.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $15.27 / $16.04
| Professional | 26 | $13.50 | $15.27 | $16.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.34 / $42.57 / $44.55
| Professional | TC | $36.34 | $42.57 | $44.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.56 / $77.29 / $220.36
| Professional | | $65.56 | $77.29 | $220.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.75 / $20.92 / $60.92
| Professional | 26 | $17.75 | $20.92 | $60.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.82 / $47.82 / $56.37
| Professional | TC | $47.82 | $47.82 | $56.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.70 / $79.43 / $220.36
| Professional | | $73.70 | $79.43 | $220.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.13 / $21.18 / $60.92
| Professional | 26 | $20.13 | $21.18 | $60.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.52 / $58.26 / $103.83
| Professional | TC | $53.52 | $58.26 | $103.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.70 / $79.43 / $220.36
| Professional | | $73.70 | $79.43 | $220.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.13 / $20.61 / $60.92
| Professional | 26 | $20.13 | $20.61 | $60.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.58 / $58.00 / $87.23
| Professional | TC | $53.58 | $58.00 | $87.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.00 / $91.72 / $234.41
| Professional | | $43.00 | $91.72 | $234.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $23.46 / $64.80
| Professional | 26 | $11.75 | $23.46 | $64.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.25 / $62.44 / $163.28
| Professional | TC | $31.25 | $62.44 | $163.28 |