- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.92 / $58.31 / $61.17
| Professional | | $50.92 | $58.31 | $61.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $16.85 / $17.10
| Professional | 26 | $14.79 | $16.85 | $17.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.45 / $41.21 / $44.32
| Professional | TC | $35.45 | $41.21 | $44.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.76 / $62.99 / $107.00
| Professional | | $49.76 | $62.99 | $107.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.18 / $19.78 / $35.36
| Professional | 26 | $15.18 | $19.78 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.04 / $44.75 / $71.63
| Professional | TC | $40.04 | $44.75 | $71.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.16 / $74.98 / $105.35
| Professional | | $58.16 | $74.98 | $105.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.87 / $22.83 / $32.08
| Professional | 26 | $17.87 | $22.83 | $32.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.13 / $52.16 / $73.28
| Professional | TC | $41.13 | $52.16 | $73.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.11 / $51.62 / $90.72
| Professional | | $51.11 | $51.62 | $90.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.89 / $17.07 / $46.05
| Professional | 26 | $16.89 | $17.07 | $46.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.21 / $39.58 / $93.22
| Professional | TC | $34.21 | $39.58 | $93.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $58.31 / $70.34
| Professional | | $48.96 | $58.31 | $70.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.05 / $16.23 / $19.37
| Professional | 26 | $15.05 | $16.23 | $19.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.72 / $41.21 / $50.97
| Professional | TC | $33.72 | $41.21 | $50.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.11 / $72.56 / $89.98
| Professional | | $51.11 | $72.56 | $89.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.04 / $22.01 / $30.00
| Professional | 26 | $15.04 | $22.01 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.74 / $50.32 / $61.60
| Professional | TC | $33.74 | $50.32 | $61.60 |