- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $8.84 / $14.27
| Facility | 26 | $8.84 | $8.84 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.89 / $35.72 / $47.35
| Professional | | $29.89 | $35.72 | $47.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.53 / $30.26
| Professional | 26 | $7.33 | $8.53 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.57 / $27.60 / $77.43
| Professional | TC | $22.57 | $27.60 | $77.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.30 / $91.69 / $95.84
| Professional | | $74.30 | $91.69 | $95.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.44 / $19.80 / $21.21
| Professional | 26 | $16.44 | $19.80 | $21.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.87 / $71.41 / $74.89
| Professional | TC | $57.87 | $71.41 | $74.89 |
- 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
- $31.71 / $57.35 / $89.84
| Professional | | $31.71 | $57.35 | $89.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.39 / $15.23 / $20.96
| Professional | 26 | $8.39 | $15.23 | $20.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.21 / $45.17 / $69.04
| Professional | TC | $22.21 | $45.17 | $69.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.97 / $65.38 / $245.68
| Professional | | $34.97 | $65.38 | $245.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.76 / $17.52 / $61.09
| Professional | 26 | $8.76 | $17.52 | $61.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.27 / $47.76 / $192.57
| Professional | TC | $26.27 | $47.76 | $192.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $62.11 / $82.46
| Professional | | $33.61 | $62.11 | $82.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.02 / $16.27 / $22.77
| Professional | 26 | $9.02 | $16.27 | $22.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.40 / $47.40 / $69.61
| Professional | TC | $26.40 | $47.40 | $69.61 |