- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.97 / $15.41 / $25.84
| Professional | | $12.97 | $15.41 | $25.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $9.86 / $75.00
| Professional | 26 | $7.71 | $9.86 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.26 / $6.42 / $9.65
| Professional | TC | $5.26 | $6.42 | $9.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.01 / $21.01 / $43.28
| Professional | | $21.01 | $21.01 | $43.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.20 / $12.20 / $25.13
| Professional | 26 | $12.20 | $12.20 | $25.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.81 / $8.81 / $18.14
| Professional | TC | $8.81 | $8.81 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.97 / $11.18 / $35.19
| Professional | | $7.97 | $11.18 | $35.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.29 / $8.73 / $25.84
| Professional | 26 | $5.29 | $8.73 | $25.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.68 / $4.63 / $12.60
| Professional | TC | $2.68 | $4.63 | $12.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.94 / $24.01 / $29.41
| Facility | | $17.94 | $24.01 | $29.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.34 / $28.80 / $77.01
| Professional | | $24.34 | $28.80 | $77.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.21 / $16.80 / $43.65
| Professional | 26 | $14.21 | $16.80 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.13 / $11.98 / $33.36
| Professional | TC | $10.13 | $11.98 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $13.57 / $50.96
| Professional | | $10.82 | $13.57 | $50.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.99 / $7.97 / $26.77
| Professional | 26 | $6.99 | $7.97 | $26.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.68 / $7.24 / $18.04
| Professional | TC | $3.68 | $7.24 | $18.04 |