- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.09 / $27.76 / $32.85
| Professional | | $21.09 | $27.76 | $32.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.04 / $21.84 / $112.14
| Professional | 26 | $16.04 | $21.84 | $112.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.05 / $7.79 / $8.58
| Professional | TC | $5.05 | $7.79 | $8.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.36 / $74.33 / $75.48
| Professional | | $67.36 | $74.33 | $75.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.68 / $53.22 / $53.44
| Professional | 26 | $47.68 | $53.22 | $53.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.68 / $21.12 / $22.05
| Professional | TC | $19.68 | $21.12 | $22.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.76 / $36.76 / $45.95
| Professional | | $36.76 | $36.76 | $45.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.02 / $26.02 / $32.52
| Professional | 26 | $26.02 | $26.02 | $32.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.74 / $10.74 / $13.42
| Professional | TC | $10.74 | $10.74 | $13.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.38 / $65.00 / $180.45
| Professional | | $36.38 | $65.00 | $180.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.72 / $50.28 / $134.87
| Professional | 26 | $27.72 | $50.28 | $134.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.66 / $15.06 / $45.58
| Professional | TC | $8.66 | $15.06 | $45.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.93 / $63.07 / $66.27
| Professional | | $30.93 | $63.07 | $66.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.57 / $46.93 / $50.28
| Professional | 26 | $23.57 | $46.93 | $50.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.36 / $15.02 / $15.99
| Professional | TC | $7.36 | $15.02 | $15.99 |