- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $22.39 / $31.62
| Facility | | $7.24 | $22.39 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $13.80 / $13.80
| Facility | 26 | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $7.24 / $8.91 / $8.91
| Facility | TC | $7.24 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $16.98 / $33.88
| Professional | | $12.02 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $19.95 / $77.62
| Professional | 26 | $7.94 | $19.95 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.01 / $7.08 / $52.48
| Professional | TC | $5.01 | $7.08 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $8.91
| Professional | | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Professional | 26 | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $38.02
| Professional | | $32.36 | $32.36 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $24.55 / $28.84
| Professional | 26 | $21.88 | $24.55 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.41 / $7.41 / $8.71
| Professional | TC | $7.41 | $7.41 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $10.72 / $32.36
| Professional | | $8.13 | $10.72 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.50 / $6.31 / $28.18
| Professional | 26 | $5.50 | $6.31 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.31 / $3.80 / $9.77
| Professional | TC | $3.31 | $3.80 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $14.45 / $23.99
| Professional | | $12.30 | $14.45 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $10.47 / $12.88
| Professional | 26 | $7.41 | $10.47 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.27 / $5.37 / $9.12
| Professional | TC | $4.27 | $5.37 | $9.12 |