- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $38.02 / $74.13
| Facility | | $20.42 | $38.02 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $15.14 / $15.14
| Facility | 26 | $12.30 | $15.14 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $8.32 / $9.77 / $38.02
| Facility | TC | $8.32 | $9.77 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $21.88 / $39.81
| Professional | | $15.14 | $21.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $15.14 / $79.43
| Professional | 26 | $8.91 | $15.14 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.01 / $7.41 / $12.59
| Professional | TC | $5.01 | $7.41 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.37 / $11.22 / $19.95
| Professional | 26 | $5.37 | $11.22 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | TC | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $23.44 / $28.84
| Professional | | $21.88 | $23.44 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $17.78
| Professional | 26 | $14.13 | $14.13 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.76 / $9.55 / $11.22
| Professional | TC | $7.76 | $9.55 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $19.05 / $19.05
| Facility | | $12.02 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $7.94 / $7.94 / $7.94
| Facility | TC | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $11.22 / $36.31
| Professional | | $9.12 | $11.22 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.62 / $8.32 / $21.88
| Professional | 26 | $5.62 | $8.32 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.16 / $4.17 / $14.13
| Professional | TC | $3.16 | $4.17 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $21.88 / $38.02
| Professional | | $11.75 | $21.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $12.88 / $22.91
| Professional | 26 | $7.59 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $4.37 / $8.71 / $16.22
| Professional | TC | $4.37 | $8.71 | $16.22 |