- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.64 / $31.90 / $31.90
| Facility | | $22.64 | $31.90 | $31.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.81 / $13.81 / $13.81
| Facility | 26 | $13.81 | $13.81 | $13.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $6.93 / $6.93 / $8.84
| Facility | TC | $6.93 | $6.93 | $8.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $18.48 / $22.65
| Professional | | $15.14 | $18.48 | $22.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.18 / $11.03 / $13.81
| Professional | 26 | $9.18 | $11.03 | $13.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.92 / $7.53 / $8.85
| Professional | TC | $5.92 | $7.53 | $8.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.99 / $8.99 / $9.52
| Professional | | $8.99 | $8.99 | $9.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.52 / $13.25 / $14.63
| Professional | 26 | $5.52 | $13.25 | $14.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $32.00 / $37.76
| Professional | | $32.00 | $32.00 | $37.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.10 / $24.56 / $28.98
| Professional | 26 | $22.10 | $24.56 | $28.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.44 / $7.44 / $8.77
| Professional | TC | $7.44 | $7.44 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $10.70 / $32.00
| Professional | | $8.19 | $10.70 | $32.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.54 / $6.31 / $28.00
| Professional | 26 | $5.54 | $6.31 | $28.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.30 / $4.26 / $9.77
| Professional | TC | $3.30 | $4.26 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.24 / $14.48 / $22.01
| Professional | | $12.24 | $14.48 | $22.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.47 / $9.51 / $14.29
| Professional | 26 | $7.47 | $9.51 | $14.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.78 / $5.41 / $9.92
| Professional | TC | $3.78 | $5.41 | $9.92 |