- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.39 / $68.33 / $86.17
| Professional | | $45.39 | $68.33 | $86.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.96 / $30.55 / $38.97
| Professional | 26 | $18.96 | $30.55 | $38.97 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $22.70 / $34.17 / $42.42
| Professional | 52 | $22.70 | $34.17 | $42.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.13 / $37.77 / $56.41
| Professional | TC | $26.13 | $37.77 | $56.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.20 / $64.70 / $86.67
| Professional | | $59.20 | $64.70 | $86.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.80 / $28.23 / $39.29
| Professional | 26 | $25.80 | $28.23 | $39.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.72 / $36.50 / $47.38
| Professional | TC | $32.72 | $36.50 | $47.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.33 / $61.33 / $61.33
| Facility | | $61.33 | $61.33 | $61.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.10 / $60.66 / $104.13
| Professional | | $49.10 | $60.66 | $104.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.05 / $26.23 / $47.21
| Professional | 26 | $22.05 | $26.23 | $47.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.70 / $33.86 / $59.69
| Professional | TC | $27.70 | $33.86 | $59.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.81 / $53.76 / $86.93
| Professional | | $41.81 | $53.76 | $86.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.43 / $23.37 / $34.97
| Professional | 26 | $16.43 | $23.37 | $34.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.46 / $31.42 / $47.71
| Professional | TC | $23.46 | $31.42 | $47.71 |