- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.28 / $10.28 / $16.60
| Facility | 26 | $10.28 | $10.28 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.83 / $31.39 / $33.89
| Professional | | $25.83 | $31.39 | $33.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.35 / $9.94 / $10.28
| Professional | 26 | $8.35 | $9.94 | $10.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.48 / $21.11 / $23.94
| Professional | TC | $17.48 | $21.11 | $23.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.12 / $77.90 / $81.42
| Professional | | $63.12 | $77.90 | $81.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.07 / $23.11 / $24.59
| Professional | 26 | $19.07 | $23.11 | $24.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.05 / $54.37 / $57.01
| Professional | TC | $44.05 | $54.37 | $57.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.79 / $10.79 / $10.79
| Facility | 26 | $10.79 | $10.79 | $10.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.42 / $55.89 / $79.81
| Professional | | $33.42 | $55.89 | $79.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.69 / $16.98 / $24.45
| Professional | 26 | $9.69 | $16.98 | $24.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.40 / $36.34 / $53.58
| Professional | TC | $22.40 | $36.34 | $53.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.58 / $59.64 / $206.60
| Professional | | $30.58 | $59.64 | $206.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $20.14 / $78.44
| Professional | 26 | $10.01 | $20.14 | $78.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.73 / $38.44 / $193.00
| Professional | TC | $20.73 | $38.44 | $193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.76 / $55.33 / $78.81
| Professional | | $31.76 | $55.33 | $78.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $18.77 / $25.63
| Professional | 26 | $10.01 | $18.77 | $25.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.14 / $36.56 / $53.19
| Professional | TC | $21.14 | $36.56 | $53.19 |