- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.05 / $31.62
| Professional | | $12.88 | $19.05 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $13.80 / $38.90
| Professional | 26 | $7.59 | $13.80 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.01 / $7.08 / $12.88
| Professional | TC | $5.01 | $7.08 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $9.12 / $9.12
| Professional | | $9.12 | $9.12 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.37 / $5.37 / $15.85
| Professional | 26 | $5.37 | $5.37 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $19.50 / $26.92
| Professional | | $12.02 | $19.50 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $38.90
| Facility | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $18.20 / $33.11
| Professional | | $8.71 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.62 / $15.14 / $25.70
| Professional | 26 | $5.62 | $15.14 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.02 / $4.57 / $13.80
| Professional | TC | $3.02 | $4.57 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $22.91 / $29.51
| Facility | | $14.79 | $22.91 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $26.30 / $131.83
| Professional | | $12.59 | $26.30 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $14.45 / $95.50
| Professional | 26 | $7.59 | $14.45 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.63 / $10.72 / $95.50
| Professional | TC | $3.63 | $10.72 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $10.96 / $18.20
| Facility | | $7.24 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $17.38 / $35.48
| Professional | | $12.59 | $17.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $11.75 / $20.89
| Professional | 26 | $6.76 | $11.75 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.63 / $5.75 / $14.45
| Professional | TC | $3.63 | $5.75 | $14.45 |