- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $17.78 / $46.77
| Facility | | $15.14 | $17.78 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $4.57 / $5.62 / $5.62
| Facility | 26 | $4.57 | $5.62 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $17.38 / $28.18
| Professional | | $10.00 | $17.38 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $4.57 / $9.33
| Professional | 26 | $3.02 | $4.57 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.08 / $12.02 / $23.44
| Professional | TC | $7.08 | $12.02 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $23.44
| Professional | | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.17 / $4.79 / $7.08
| Professional | 26 | $4.17 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Professional | TC | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $19.50 / $30.90
| Professional | | $18.62 | $19.50 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.25 / $5.25 / $6.31
| Professional | 26 | $5.25 | $5.25 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.18 / $14.13 / $25.70
| Professional | TC | $13.18 | $14.13 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $15.85 / $15.85
| Facility | | $14.13 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.37 / $4.37 / $4.37
| Professional | 26 | $4.37 | $4.37 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $11.75 / $29.51
| Professional | | $7.24 | $11.75 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.04 / $2.75 / $8.13
| Professional | 26 | $2.04 | $2.75 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.25 / $9.12 / $21.88
| Professional | TC | $5.25 | $9.12 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $15.85 / $35.48
| Professional | | $8.71 | $15.85 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.75 / $4.79 / $8.71
| Professional | 26 | $2.75 | $4.79 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.46 / $11.22 / $28.84
| Professional | TC | $6.46 | $11.22 | $28.84 |