- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.72 / $17.53 / $34.08
| Professional | | $13.72 | $17.53 | $34.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.18 / $13.90 / $66.50
| Professional | 26 | $9.18 | $13.90 | $66.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.28 / $6.67 / $12.94
| Professional | TC | $5.28 | $6.67 | $12.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $9.34 / $20.03
| Professional | | $9.34 | $9.34 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.64 / $12.13 / $16.21
| Professional | 26 | $5.64 | $12.13 | $16.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.63 / $21.00 / $22.05
| Professional | | $18.63 | $21.00 | $22.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.28 / $19.00 / $25.50
| Professional | 26 | $11.28 | $19.00 | $25.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.35 / $7.35 / $31.81
| Professional | TC | $7.35 | $7.35 | $31.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.10 / $10.48 / $30.00
| Professional | | $8.10 | $10.48 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.45 / $6.31 / $33.75
| Professional | 26 | $5.45 | $6.31 | $33.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.40 / $4.03 / $9.03
| Professional | TC | $2.40 | $4.03 | $9.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.09 / $26.00 / $31.00
| Facility | | $16.09 | $26.00 | $31.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $22.00 / $34.00
| Facility | 26 | $16.98 | $22.00 | $34.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $7.84 / $8.31 / $13.64
| Facility | TC | $7.84 | $8.31 | $13.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $16.51 / $39.40
| Professional | | $10.72 | $16.51 | $39.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.86 / $8.73 / $25.98
| Professional | 26 | $6.86 | $8.73 | $25.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.23 / $5.41 / $12.62
| Professional | TC | $3.23 | $5.41 | $12.62 |