- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $8.84 / $11.56
| Facility | 26 | $7.76 | $8.84 | $11.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.02 / $34.29 / $47.65
| Professional | | $29.02 | $34.29 | $47.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.30 / $7.82 / $11.61
| Professional | 26 | $7.30 | $7.82 | $11.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.51 / $26.53 / $33.40
| Professional | TC | $21.51 | $26.53 | $33.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.59 / $37.90 / $37.90
| Professional | | $29.59 | $37.90 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.16 / $7.13 / $11.61
| Professional | 26 | $6.16 | $7.13 | $11.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.77 / $39.15 / $39.15
| Professional | TC | $27.77 | $39.15 | $39.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.86 / $30.31 / $48.19
| Professional | | $26.86 | $30.31 | $48.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.11 / $11.40 / $15.73
| Professional | 26 | $9.11 | $11.40 | $15.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.86 / $18.91 / $30.25
| Professional | TC | $17.86 | $18.91 | $30.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $31.32 / $45.70
| Professional | | $8.22 | $31.32 | $45.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.65 / $41.38 / $77.77
| Professional | | $29.65 | $41.38 | $77.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $11.06 / $18.23
| Professional | 26 | $7.71 | $11.06 | $18.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.32 / $28.19 / $59.90
| Professional | TC | $21.32 | $28.19 | $59.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.65 / $36.75 / $66.12
| Professional | | $28.65 | $36.75 | $66.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.67 / $9.25 / $15.56
| Professional | 26 | $7.67 | $9.25 | $15.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.63 / $26.84 / $47.76
| Professional | TC | $20.63 | $26.84 | $47.76 |