- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.03 / $51.03 / $92.23
| Professional | | $51.03 | $51.03 | $92.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.91 / $18.91 / $29.74
| Professional | 26 | $18.91 | $18.91 | $29.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.11 / $32.11 / $62.48
| Professional | TC | $32.11 | $32.11 | $62.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.16 / $99.73 / $199.12
| Professional | | $26.16 | $99.73 | $199.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.00 / $35.43 / $52.38
| Professional | 26 | $9.00 | $35.43 | $52.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.16 / $64.31 / $89.66
| Professional | TC | $17.16 | $64.31 | $89.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.15 / $65.02 / $101.23
| Professional | | $45.15 | $65.02 | $101.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.82 / $21.85 / $39.79
| Professional | 26 | $13.82 | $21.85 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.27 / $45.22 / $111.43
| Professional | TC | $25.27 | $45.22 | $111.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.77 / $100.15 / $153.63
| Professional | | $59.77 | $100.15 | $153.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.79 / $32.15 / $58.16
| Professional | 26 | $26.79 | $32.15 | $58.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $59.77 / $71.72 / $129.75
| Professional | TC | $59.77 | $71.72 | $129.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.03 / $70.00 / $161.22
| Professional | | $51.03 | $70.00 | $161.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.91 / $20.35 / $54.15
| Professional | 26 | $18.91 | $20.35 | $54.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.11 / $47.35 / $107.08
| Professional | TC | $32.11 | $47.35 | $107.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.39 / $73.18 / $153.16
| Professional | | $41.39 | $73.18 | $153.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.96 / $31.00 / $56.76
| Professional | 26 | $12.96 | $31.00 | $56.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.43 / $54.29 / $106.09
| Professional | TC | $28.43 | $54.29 | $106.09 |