- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $24.71 / $35.42
| Professional | | $16.80 | $24.71 | $35.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.09 / $5.03 / $7.07
| Professional | 26 | $3.09 | $5.03 | $7.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.07 / $19.69 / $28.35
| Professional | TC | $13.07 | $19.69 | $28.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.21 / $4.21 / $23.66
| Professional | | $4.21 | $4.21 | $23.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $4.21 / $4.21 / $5.00
| Facility | 26 | $4.21 | $4.21 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.64 / $28.00 / $62.99
| Professional | | $14.64 | $28.00 | $62.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.69 / $5.82 / $11.88
| Professional | 26 | $2.69 | $5.82 | $11.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.97 / $22.31 / $48.85
| Professional | TC | $11.97 | $22.31 | $48.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $4.21 / $4.21 / $5.00
| Facility | 26 | $4.21 | $4.21 | $5.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.95 / $31.05 / $46.68
| Professional | | $17.95 | $31.05 | $46.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.69 / $5.33 / $9.31
| Professional | 26 | $2.69 | $5.33 | $9.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.95 / $19.57 / $32.59
| Professional | TC | $11.95 | $19.57 | $32.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.98 / $37.18 / $41.59
| Professional | | $28.98 | $37.18 | $41.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.11 / $7.67 / $9.38
| Professional | 26 | $6.11 | $7.67 | $9.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.46 / $29.01 / $33.29
| Professional | TC | $23.46 | $29.01 | $33.29 |