- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $50.12
| Professional | | $10.96 | $14.13 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.12 / $33.11
| Professional | 26 | $7.08 | $9.12 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.02 / $3.98 / $6.03
| Professional | TC | $3.02 | $3.98 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Facility | 26 | $53.70 | $53.70 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Facility | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $20.89 / $47.86
| Professional | | $15.14 | $20.89 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.62 / $13.18 / $32.36
| Professional | 26 | $5.62 | $13.18 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.37 / $7.24 / $16.98
| Professional | TC | $4.37 | $7.24 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $12.30 / $47.86
| Professional | | $11.48 | $12.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $8.51 / $32.36
| Professional | 26 | $7.76 | $8.51 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.63 / $3.89 / $5.25
| Professional | TC | $3.63 | $3.89 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.14 / $32.36
| Professional | | $12.02 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $10.00 / $20.89
| Professional | 26 | $8.13 | $10.00 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.47 / $4.37 / $9.77
| Professional | TC | $3.47 | $4.37 | $9.77 |