- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $20.89
| Professional | | $8.91 | $12.02 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.00 / $3.02 / $10.47
| Professional | 26 | $2.00 | $3.02 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.03 / $8.91 / $15.14
| Professional | TC | $6.03 | $8.91 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $24.55 / $30.90
| Professional | | $6.46 | $24.55 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.86 / $7.08 / $12.30
| Professional | 26 | $1.86 | $7.08 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.79 / $17.38 / $22.91
| Professional | TC | $4.79 | $17.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $18.62 / $37.15
| Professional | | $12.30 | $18.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.47 / $5.62 / $25.12
| Professional | 26 | $3.47 | $5.62 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.71 / $12.02 / $27.54
| Professional | TC | $8.71 | $12.02 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $25.12 / $46.77
| Professional | | $20.42 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.37 / $6.61 / $12.30
| Professional | 26 | $5.37 | $6.61 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.79 / $18.20 / $33.88
| Professional | TC | $14.79 | $18.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $20.89 / $38.02
| Professional | | $10.96 | $20.89 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $8.32 / $16.60
| Professional | 26 | $3.02 | $8.32 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.94 / $15.14 / $27.54
| Professional | TC | $7.94 | $15.14 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $24.55 / $46.77
| Professional | | $14.45 | $24.55 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.51 / $6.61 / $12.30
| Professional | 26 | $2.51 | $6.61 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.24 / $16.98 / $33.88
| Professional | TC | $7.24 | $16.98 | $33.88 |