- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $95.50 / $281.84
| Professional | | $72.44 | $95.50 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $54.95 / $194.98
| Professional | 26 | $42.66 | $54.95 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $35.48 / $69.18
| Professional | TC | $25.12 | $35.48 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $112.20 / $309.03
| Professional | | $93.33 | $112.20 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $134.90 / $186.21
| Professional | | $87.10 | $134.90 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $54.95 / $81.28 / $97.72
| Professional | 26 | $54.95 | $81.28 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $45.71 / $93.33
| Professional | TC | $27.54 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $109.65 / $309.03
| Professional | | $95.50 | $109.65 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $63.10 / $151.36
| Professional | 26 | $53.70 | $63.10 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $56.23 / $72.44
| Professional | TC | $32.36 | $56.23 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $109.65 / $194.98
| Professional | | $79.43 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $72.44 / $97.72
| Professional | 26 | $41.69 | $72.44 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $44.67 / $102.33
| Professional | TC | $32.36 | $44.67 | $102.33 |