- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.15 / $44.60 / $62.60
| Professional | | $34.15 | $44.60 | $62.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.71 / $19.57 / $22.91
| Professional | 26 | $14.71 | $19.57 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $24.37 / $34.61
| Professional | TC | $17.78 | $24.37 | $34.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.41 / $42.41 / $42.41
| Professional | | $42.41 | $42.41 | $42.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.41 / $44.00 / $63.26
| Professional | | $42.41 | $44.00 | $63.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.11 / $35.00 / $45.45
| Professional | 26 | $19.11 | $35.00 | $45.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.00 / $11.96 / $29.25
| Professional | TC | $9.00 | $11.96 | $29.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.57 / $55.93 / $77.64
| Professional | | $38.57 | $55.93 | $77.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.77 / $23.23 / $35.29
| Professional | 26 | $17.77 | $23.23 | $35.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.58 / $32.28 / $45.17
| Professional | TC | $20.58 | $32.28 | $45.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.00 / $25.00 / $37.08
| Facility | 26 | $23.00 | $25.00 | $37.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.30 / $36.91 / $44.92
| Professional | | $31.30 | $36.91 | $44.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.88 / $45.65 / $64.54
| Professional | | $34.88 | $45.65 | $64.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.98 / $19.80 / $26.51
| Professional | 26 | $14.98 | $19.80 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.35 / $24.24 / $41.15
| Professional | TC | $19.35 | $24.24 | $41.15 |