- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.40 / $55.40 / $60.52
| Professional | | $53.40 | $55.40 | $60.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.15 / $9.19 / $9.50
| Professional | 26 | $9.15 | $9.19 | $9.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.20 / $46.25 / $51.02
| Professional | TC | $44.20 | $46.25 | $51.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.37 / $135.12 / $138.25
| Professional | | $123.37 | $135.12 | $138.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.68 / $20.73 / $22.05
| Professional | 26 | $19.68 | $20.73 | $22.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.70 / $111.17 / $116.56
| Professional | TC | $103.70 | $111.17 | $116.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $83.41 / $145.16
| Professional | | $38.65 | $83.41 | $145.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.89 / $13.19 / $22.13
| Professional | 26 | $5.89 | $13.19 | $22.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.76 / $70.11 / $123.03
| Professional | TC | $32.76 | $70.11 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.92 / $80.01 / $343.33
| Professional | | $47.92 | $80.01 | $343.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.10 / $13.52 / $166.76
| Professional | 26 | $8.10 | $13.52 | $166.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.82 / $66.56 / $288.04
| Professional | TC | $39.82 | $66.56 | $288.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.12 / $67.83 / $112.76
| Professional | | $46.12 | $67.83 | $112.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $12.36 / $21.01
| Professional | 26 | $7.97 | $12.36 | $21.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.04 / $57.43 / $93.70
| Professional | TC | $39.04 | $57.43 | $93.70 |