- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $22.39 / $28.18
| Professional | | $8.91 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $8.91 / $16.60
| Professional | 26 | $3.02 | $8.91 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.03 / $15.14 / $22.39
| Professional | TC | $6.03 | $15.14 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.38 / $38.90
| Professional | | $10.72 | $17.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $5.37 / $9.55
| Professional | 26 | $2.29 | $5.37 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.71 / $13.18 / $28.18
| Professional | TC | $8.71 | $13.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $20.89 / $23.99
| Professional | | $16.60 | $20.89 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.68 / $6.61 / $7.76
| Professional | 26 | $4.68 | $6.61 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.30 / $14.45 / $16.22
| Professional | TC | $12.30 | $14.45 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $24.55 / $34.67
| Professional | | $16.98 | $24.55 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.37 / $6.61 / $10.47
| Professional | 26 | $4.37 | $6.61 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.59 / $15.49 / $23.99
| Professional | TC | $12.59 | $15.49 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $13.49 / $28.18
| Professional | | $5.13 | $13.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $15.85 / $29.51
| Professional | | $9.55 | $15.85 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.57 / $4.37 / $7.08
| Professional | 26 | $2.57 | $4.37 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.76 / $11.22 / $22.39
| Professional | TC | $6.76 | $11.22 | $22.39 |