- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.01 / $50.37 / $66.80
| Professional | | $44.01 | $50.37 | $66.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $8.74 / $11.52
| Professional | 26 | $7.24 | $8.74 | $11.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.86 / $42.12 / $55.28
| Professional | TC | $36.86 | $42.12 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $54.66 / $108.90
| Professional | | $34.32 | $54.66 | $108.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.94 / $10.07 / $18.77
| Professional | 26 | $5.94 | $10.07 | $18.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.81 / $45.89 / $89.42
| Professional | TC | $29.81 | $45.89 | $89.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.19 / $56.50 / $114.04
| Professional | | $37.19 | $56.50 | $114.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $10.43 / $20.46
| Professional | 26 | $6.92 | $10.43 | $20.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.79 / $46.76 / $93.59
| Professional | TC | $32.79 | $46.76 | $93.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.33 / $343.33 / $459.30
| Professional | | $343.33 | $343.33 | $459.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $166.76 / $166.76 / $166.76
| Professional | 26 | $166.76 | $166.76 | $166.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $288.04 / $288.04 / $388.73
| Professional | TC | $288.04 | $288.04 | $388.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.26 / $46.78 / $62.36
| Professional | | $32.26 | $46.78 | $62.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.62 / $8.63 / $12.36
| Professional | 26 | $6.62 | $8.63 | $12.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.63 / $39.68 / $60.36
| Professional | TC | $26.63 | $39.68 | $60.36 |