- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.42 / $21.21 / $31.06
| Professional | | $17.42 | $21.21 | $31.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.14 / $9.73 / $15.66
| Professional | 26 | $9.14 | $9.73 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.15 / $11.48 / $15.39
| Professional | TC | $8.15 | $11.48 | $15.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.25 / $15.25 / $28.92
| Professional | | $15.25 | $15.25 | $28.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.25 / $15.25 / $18.85
| Facility | 26 | $15.25 | $15.25 | $18.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.50 / $33.17 / $43.45
| Professional | | $25.50 | $33.17 | $43.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $15.25 / $24.61
| Professional | 26 | $9.94 | $15.25 | $24.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.72 / $16.66 / $22.93
| Professional | TC | $11.72 | $16.66 | $22.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.25 / $15.25 / $18.85
| Facility | 26 | $15.25 | $15.25 | $18.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $28.92 / $45.25
| Professional | | $17.39 | $28.92 | $45.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.84 / $15.83 / $22.00
| Professional | 26 | $9.84 | $15.83 | $22.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.72 / $14.55 / $20.54
| Professional | TC | $11.72 | $14.55 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.48 / $21.76 / $34.22
| Professional | | $19.48 | $21.76 | $34.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.70 / $11.46 / $26.83
| Professional | 26 | $10.70 | $11.46 | $26.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.66 / $11.06 / $15.66
| Professional | TC | $8.66 | $11.06 | $15.66 |