- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.69 / $21.86 / $27.98
| Professional | | $20.69 | $21.86 | $27.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.79 / $16.63 / $31.82
| Professional | 26 | $15.79 | $16.63 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.90 / $5.23 / $6.69
| Professional | TC | $4.90 | $5.23 | $6.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $13.55 / $13.55
| Professional | | $13.55 | $13.55 | $13.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.02 / $9.83 / $9.85
| Professional | 26 | $9.02 | $9.83 | $9.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.78 / $38.67 / $54.73
| Professional | | $24.78 | $38.67 | $54.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.30 / $31.05 / $41.13
| Professional | 26 | $18.30 | $31.05 | $41.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.69 / $8.89 / $13.59
| Professional | TC | $5.69 | $8.89 | $13.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $10.62 / $38.39
| Facility | 26 | $9.94 | $10.62 | $38.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $21.22 / $52.97
| Professional | | $13.79 | $21.22 | $52.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.44 / $20.88 / $44.51
| Professional | 26 | $10.44 | $20.88 | $44.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.24 / $4.86 / $12.35
| Professional | TC | $3.24 | $4.86 | $12.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.61 / $95.38 / $104.98
| Facility | 26 | $49.61 | $95.38 | $104.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.45 / $180.45 / $242.63
| Professional | | $180.45 | $180.45 | $242.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $134.87 / $134.87 / $169.13
| Professional | 26 | $134.87 | $134.87 | $169.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.58 / $45.58 / $73.58
| Professional | TC | $45.58 | $45.58 | $73.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.67 / $26.63 / $52.36
| Professional | | $16.67 | $26.63 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.07 / $19.98 / $41.11
| Professional | 26 | $13.07 | $19.98 | $41.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.88 / $6.40 / $14.08
| Professional | TC | $3.88 | $6.40 | $14.08 |