- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $63.10 / $186.21
| Professional | | $52.48 | $63.10 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.00 / $25.12
| Professional | 26 | $7.94 | $10.00 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $51.29 / $81.28
| Professional | TC | $42.66 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Professional | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $12.30 / $12.30
| Professional | 26 | $10.47 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $67.61 / $67.61
| Professional | TC | $56.23 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $77.62 / $245.47
| Professional | | $61.66 | $77.62 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $12.59 / $35.48
| Professional | 26 | $10.00 | $12.59 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $64.57 / $208.93
| Professional | TC | $52.48 | $64.57 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $77.62 / $208.93
| Professional | | $58.88 | $77.62 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $12.88 / $31.62
| Professional | 26 | $9.55 | $12.88 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.12 / $63.10 / $114.82
| Professional | TC | $50.12 | $63.10 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $81.28 / $131.83
| Professional | | $51.29 | $81.28 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $12.30 / $19.95
| Professional | 26 | $8.32 | $12.30 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $67.61 / $112.20
| Professional | TC | $43.65 | $67.61 | $112.20 |