- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.66 / $13.58 / $16.41
| Facility | 26 | $10.66 | $13.58 | $16.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.89 / $39.03 / $63.34
| Professional | | $31.89 | $39.03 | $63.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.42 / $10.98 / $18.98
| Professional | 26 | $9.42 | $10.98 | $18.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.67 / $27.69 / $47.26
| Professional | TC | $22.67 | $27.69 | $47.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.96 / $55.11 / $79.30
| Professional | | $39.96 | $55.11 | $79.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.20 / $14.70 / $21.11
| Professional | 26 | $11.20 | $14.70 | $21.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.00 / $40.51 / $58.29
| Professional | TC | $29.00 | $40.51 | $58.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.00 / $48.83 / $84.49
| Professional | | $33.00 | $48.83 | $84.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $14.82 / $26.66
| Professional | 26 | $9.55 | $14.82 | $26.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.10 / $32.77 / $55.37
| Professional | TC | $22.10 | $32.77 | $55.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $70.34 / $75.04
| Professional | | $70.34 | $70.34 | $75.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.43 / $61.59 / $83.64
| Professional | | $49.43 | $61.59 | $83.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.22 / $16.48 / $22.37
| Professional | 26 | $13.22 | $16.48 | $22.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.22 / $45.13 / $61.29
| Professional | TC | $36.22 | $45.13 | $61.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.97 / $59.47 / $97.15
| Professional | | $37.97 | $59.47 | $97.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $18.48 / $28.88
| Professional | 26 | $11.75 | $18.48 | $28.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.62 / $41.23 / $61.87
| Professional | TC | $25.62 | $41.23 | $61.87 |