- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $26.40 / $185.02
| Facility | | $23.58 | $26.40 | $185.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.66 / $3.75 / $4.20
| Facility | 26 | $3.66 | $3.75 | $4.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.34 / $26.40 / $39.11
| Professional | | $18.34 | $26.40 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.41 / $3.91 / $5.19
| Professional | 26 | $2.41 | $3.91 | $5.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $7.74 / $11.89 / $15.52
| Professional | 52 | $7.74 | $11.89 | $15.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.93 / $22.20 / $34.51
| Professional | TC | $15.93 | $22.20 | $34.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.48 / $98.76 / $148.47
| Facility | | $57.48 | $98.76 | $148.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.28 / $25.14 / $30.08
| Professional | | $23.28 | $25.14 | $30.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.21 / $3.47 / $4.78
| Professional | 26 | $3.21 | $3.47 | $4.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.07 / $21.68 / $25.32
| Professional | TC | $20.07 | $21.68 | $25.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.07 / $22.07 / $22.67
| Facility | | $22.07 | $22.07 | $22.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.94 / $20.67 / $20.67
| Professional | 26 | $2.94 | $20.67 | $20.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.91 / $20.91 / $20.91
| Facility | | $20.91 | $20.91 | $20.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.42 / $25.93 / $45.96
| Professional | | $18.42 | $25.93 | $45.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.65 / $3.63 / $7.50
| Professional | 26 | $2.65 | $3.63 | $7.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.95 / $22.45 / $35.36
| Professional | TC | $15.95 | $22.45 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $24.62 / $45.76
| Professional | | $17.89 | $24.62 | $45.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.63 / $3.51 / $10.02
| Professional | 26 | $2.63 | $3.51 | $10.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.25 / $19.13 / $35.59
| Professional | TC | $15.25 | $19.13 | $35.59 |