- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.24 / $42.39 / $54.41
| Professional | | $40.24 | $42.39 | $54.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.40 / $28.86 / $37.99
| Professional | 26 | $27.40 | $28.86 | $37.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.84 / $13.69 / $17.84
| Professional | TC | $12.84 | $13.69 | $17.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.97 / $23.09 / $42.41
| Professional | 26 | $16.97 | $23.09 | $42.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.68 / $74.51 / $115.88
| Professional | | $46.68 | $74.51 | $115.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.02 / $54.77 / $75.76
| Professional | 26 | $33.02 | $54.77 | $75.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.50 / $25.09 / $46.19
| Professional | TC | $15.50 | $25.09 | $46.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.34 / $17.46 / $54.53
| Facility | 26 | $16.34 | $17.46 | $54.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.96 / $40.33 / $105.36
| Professional | | $25.96 | $40.33 | $105.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.30 / $28.64 / $69.70
| Professional | 26 | $17.30 | $28.64 | $69.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.63 / $11.60 / $30.69
| Professional | TC | $7.63 | $11.60 | $30.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $86.13 / $165.02 / $182.16
| Facility | 26 | $86.13 | $165.02 | $182.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.10 / $353.10 / $455.70
| Professional | | $353.10 | $353.10 | $455.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $231.59 / $231.59 / $291.60
| Professional | 26 | $231.59 | $231.59 | $291.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $121.51 / $121.51 / $164.10
| Professional | TC | $121.51 | $121.51 | $164.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $54.37 / $109.03
| Professional | | $32.61 | $54.37 | $109.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.40 / $35.35 / $68.55
| Professional | 26 | $21.40 | $35.35 | $68.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.71 / $16.19 / $34.25
| Professional | TC | $9.71 | $16.19 | $34.25 |