- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.88 / $46.66 / $72.73
| Professional | | $36.88 | $46.66 | $72.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $20.84 / $35.83
| Professional | 26 | $17.38 | $20.84 | $35.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.54 / $25.82 / $51.18
| Professional | TC | $12.54 | $25.82 | $51.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.71 / $24.71 / $52.58
| Professional | | $24.71 | $24.71 | $52.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.69 / $26.69 / $52.58
| Facility | | $26.69 | $26.69 | $52.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $24.71 / $24.71
| Facility | 26 | $24.71 | $24.71 | $24.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $47.32 / $53.13
| Professional | | $37.15 | $47.32 | $53.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.23 / $22.24 / $24.97
| Professional | 26 | $18.23 | $22.24 | $24.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.89 / $24.74 / $28.16
| Professional | TC | $18.89 | $24.74 | $28.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.10 / $38.22 / $69.43
| Facility | | $29.10 | $38.22 | $69.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.71 / $24.71 / $24.71
| Facility | 26 | $24.71 | $24.71 | $24.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $47.07 / $61.88
| Professional | | $31.38 | $47.07 | $61.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.52 / $22.24 / $24.80
| Professional | 26 | $20.52 | $22.24 | $24.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $24.74 / $27.87
| Professional | TC | $21.26 | $24.74 | $27.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.66 / $55.67 / $79.80
| Professional | | $44.66 | $55.67 | $79.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.54 / $25.76 / $30.15
| Professional | 26 | $22.54 | $25.76 | $30.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.11 / $28.43 / $45.65
| Professional | TC | $22.11 | $28.43 | $45.65 |