- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.40 / $88.26 / $165.44
| Professional | | $79.40 | $88.26 | $165.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.96 / $80.59 / $509.70
| Professional | 26 | $50.96 | $80.59 | $509.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.42 / $34.11 / $71.08
| Professional | TC | $28.42 | $34.11 | $71.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.30 / $133.56 / $431.62
| Professional | | $113.30 | $133.56 | $431.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.65 / $132.60 / $431.62
| Professional | | $108.65 | $132.60 | $431.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.48 / $89.42 / $256.49
| Professional | 26 | $73.48 | $89.42 | $256.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.17 / $50.74 / $54.39
| Professional | TC | $35.17 | $50.74 | $54.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.46 / $108.65 / $148.40
| Professional | | $94.46 | $108.65 | $148.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $58.22 / $75.11 / $94.01
| Professional | 26 | $58.22 | $75.11 | $94.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.17 / $39.46 / $54.39
| Professional | TC | $35.17 | $39.46 | $54.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.20 / $121.81 / $306.08
| Professional | | $60.20 | $121.81 | $306.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.11 / $65.19 / $181.89
| Professional | 26 | $39.11 | $65.19 | $181.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.93 / $35.14 / $124.20
| Professional | TC | $21.93 | $35.14 | $124.20 |