- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.17 / $66.05 / $94.37
| Professional | | $65.17 | $66.05 | $94.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $43.77 / $71.02 / $192.02
| Professional | 26 | $43.77 | $71.02 | $192.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.41 / $21.70 / $31.42
| Professional | TC | $21.41 | $21.70 | $31.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.93 / $27.93 / $27.93
| Professional | 26 | $27.93 | $27.93 | $27.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.20 / $89.95 / $123.51
| Professional | | $60.20 | $89.95 | $123.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.71 / $92.24 / $162.00
| Professional | | $41.71 | $92.24 | $162.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.50 / $63.00 / $106.00
| Professional | 26 | $28.50 | $63.00 | $106.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.25 / $21.14 / $56.00
| Professional | TC | $12.25 | $21.14 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.59 / $123.09 / $587.10
| Professional | | $53.59 | $123.09 | $587.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.77 / $88.34 / $381.48
| Professional | 26 | $35.77 | $88.34 | $381.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.39 / $34.54 / $205.55
| Professional | TC | $15.39 | $34.54 | $205.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.21 / $55.22 / $138.05
| Professional | | $53.21 | $55.22 | $138.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.24 / $59.61 / $104.95
| Professional | 26 | $35.24 | $59.61 | $104.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.35 / $29.22 / $45.03
| Professional | TC | $15.35 | $29.22 | $45.03 |