- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.58 / $61.60 / $77.44
| Facility | | $44.58 | $61.60 | $77.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.35 / $27.35 / $27.35
| Facility | 26 | $27.35 | $27.35 | $27.35 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $17.23 / $17.23 / $54.60
| Facility | TC | $17.23 | $17.23 | $54.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.53 / $37.47 / $44.58
| Professional | | $17.53 | $37.47 | $44.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.66 / $22.99 / $27.35
| Professional | 26 | $10.66 | $22.99 | $27.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.87 / $14.48 / $17.23
| Professional | TC | $6.87 | $14.48 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.47 / $16.47 / $19.38
| Professional | | $16.47 | $16.47 | $19.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $10.10 / $11.89
| Professional | 26 | $9.86 | $10.10 | $11.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.37 / $6.37 / $7.49
| Professional | TC | $6.37 | $6.37 | $7.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.91 / $29.30 / $41.22
| Facility | | $24.91 | $29.30 | $41.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.54 / $33.36 / $36.50
| Professional | | $32.54 | $33.36 | $36.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.21 / $20.37 / $21.53
| Professional | 26 | $19.21 | $20.37 | $21.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.35 / $14.16 / $21.53
| Professional | TC | $13.35 | $14.16 | $21.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.04 / $32.34 / $35.76
| Professional | | $14.04 | $32.34 | $35.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.36 / $35.72 / $36.07
| Professional | | $33.36 | $35.72 | $36.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.37 / $20.49 / $21.18
| Professional | 26 | $20.37 | $20.49 | $21.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.00 / $14.89 / $15.22
| Professional | TC | $13.00 | $14.89 | $15.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.44 / $13.21 / $26.14
| Professional | | $11.44 | $13.21 | $26.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.15 / $7.80 / $12.99
| Professional | 26 | $7.15 | $7.80 | $12.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.29 / $5.41 / $10.47
| Professional | TC | $4.29 | $5.41 | $10.47 |