- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.15 / $27.67 / $42.65
| Professional | | $22.15 | $27.67 | $42.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.49 / $13.70 / $18.02
| Professional | 26 | $10.49 | $13.70 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.66 / $13.96 / $23.32
| Professional | TC | $11.66 | $13.96 | $23.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.40 / $31.50 / $43.25
| Professional | | $15.40 | $31.50 | $43.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.12 / $38.78 / $63.61
| Professional | | $22.12 | $38.78 | $63.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $18.32 / $24.70
| Professional | 26 | $11.16 | $18.32 | $24.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $19.82 / $41.33
| Professional | TC | $10.96 | $19.82 | $41.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.52 / $29.05 / $69.33
| Facility | | $23.52 | $29.05 | $69.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.40 / $36.40 / $100.00
| Facility | 26 | $36.40 | $36.40 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $36.00 / $82.90
| Professional | | $27.43 | $36.00 | $82.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.28 / $16.57 / $98.32
| Professional | 26 | $13.28 | $16.57 | $98.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.15 / $17.69 / $180.44
| Professional | TC | $14.15 | $17.69 | $180.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.43 / $32.58 / $55.47
| Professional | | $27.43 | $32.58 | $55.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.69 / $15.77 / $21.63
| Professional | 26 | $12.69 | $15.77 | $21.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.15 / $17.16 / $35.69
| Professional | TC | $14.15 | $17.16 | $35.69 |