- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.53 / $64.34 / $104.67
| Professional | | $59.53 | $64.34 | $104.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.64 / $29.82 / $42.01
| Professional | 26 | $26.64 | $29.82 | $42.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.38 / $34.52 / $62.65
| Professional | TC | $32.38 | $34.52 | $62.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.19 / $97.50 / $223.98
| Professional | | $85.19 | $97.50 | $223.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.24 / $38.24 / $99.43
| Professional | 26 | $38.24 | $38.24 | $99.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.95 / $46.95 / $53.73
| Professional | TC | $46.95 | $46.95 | $53.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.98 / $89.36 / $264.73
| Professional | | $66.98 | $89.36 | $264.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.64 / $38.64 / $99.43
| Professional | 26 | $31.64 | $38.64 | $99.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.84 / $44.53 / $158.26
| Professional | TC | $34.84 | $44.53 | $158.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.98 / $86.77 / $258.64
| Professional | | $66.98 | $86.77 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.64 / $40.61 / $99.43
| Professional | 26 | $31.64 | $40.61 | $99.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.84 / $43.19 / $157.47
| Professional | TC | $34.84 | $43.19 | $157.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.26 / $84.17 / $244.68
| Professional | | $57.26 | $84.17 | $244.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.77 / $41.90 / $117.99
| Professional | 26 | $27.77 | $41.90 | $117.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.49 / $43.58 / $126.69
| Professional | TC | $29.49 | $43.58 | $126.69 |