- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $12.68 / $21.66
| Professional | | $12.00 | $12.68 | $21.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.70 / $3.70 / $5.81
| Professional | 26 | $3.70 | $3.70 | $5.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.98 / $8.98 / $15.84
| Professional | TC | $8.98 | $8.98 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.23 / $24.53 / $41.97
| Professional | | $6.23 | $24.53 | $41.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.80 / $7.09 / $12.35
| Professional | 26 | $1.80 | $7.09 | $12.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.43 / $17.44 / $22.88
| Professional | TC | $4.43 | $17.44 | $22.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $16.11 / $33.26
| Professional | | $12.24 | $16.11 | $33.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.88 / $4.63 / $10.02
| Professional | 26 | $2.88 | $4.63 | $10.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.21 / $12.00 / $27.37
| Professional | TC | $7.21 | $12.00 | $27.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.64 / $23.85 / $44.74
| Professional | | $11.64 | $23.85 | $44.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.36 / $6.20 / $9.51
| Professional | 26 | $5.36 | $6.20 | $9.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.25 / $18.30 / $33.10
| Professional | TC | $15.25 | $18.30 | $33.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.84 / $14.82 / $33.52
| Professional | | $9.84 | $14.82 | $33.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.89 / $3.98 / $10.43
| Professional | 26 | $2.89 | $3.98 | $10.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.95 / $12.00 / $25.64
| Professional | TC | $6.95 | $12.00 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.74 / $15.88 / $38.07
| Professional | | $9.74 | $15.88 | $38.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.44 / $6.40 / $11.11
| Professional | 26 | $4.44 | $6.40 | $11.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.20 / $14.15 / $26.96
| Professional | TC | $7.20 | $14.15 | $26.96 |