- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.64 / $10.64 / $17.19
| Facility | 26 | $10.64 | $10.64 | $17.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.04 / $19.12 / $31.06
| Professional | | $15.04 | $19.12 | $31.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.66 / $9.73 / $12.67
| Professional | 26 | $8.66 | $9.73 | $12.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.38 / $8.65 / $12.62
| Professional | TC | $6.38 | $8.65 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.07 / $44.09 / $48.34
| Professional | | $33.07 | $44.09 | $48.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.72 / $23.94 / $25.45
| Professional | 26 | $19.72 | $23.94 | $25.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.75 / $21.46 / $22.90
| Professional | TC | $17.75 | $21.46 | $22.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $11.16 / $11.16
| Facility | 26 | $11.16 | $11.16 | $11.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $35.92 / $51.44
| Professional | | $22.07 | $35.92 | $51.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.03 / $18.27 / $25.32
| Professional | 26 | $10.03 | $18.27 | $25.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.09 / $18.67 / $27.69
| Professional | TC | $10.09 | $18.67 | $27.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.77 / $39.31 / $206.87
| Professional | | $20.77 | $39.31 | $206.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.53 / $21.20 / $105.66
| Professional | 26 | $10.53 | $21.20 | $105.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.31 / $18.11 / $129.58
| Professional | TC | $9.31 | $18.11 | $129.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.77 / $35.49 / $47.82
| Professional | | $20.77 | $35.49 | $47.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.83 / $19.79 / $26.53
| Professional | 26 | $10.83 | $19.79 | $26.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.31 / $16.96 / $24.72
| Professional | TC | $9.31 | $16.96 | $24.72 |