- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.08 / $9.21 / $11.56
| Facility | 26 | $8.08 | $9.21 | $11.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.92 / $28.88 / $57.32
| Professional | | $24.92 | $28.88 | $57.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.34 / $16.21
| Professional | 26 | $7.33 | $8.34 | $16.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.97 / $20.30 / $30.60
| Professional | TC | $16.97 | $20.30 | $30.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.42 / $24.68 / $24.68
| Professional | | $23.42 | $24.68 | $24.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.45 / $9.02 / $12.39
| Professional | 26 | $6.45 | $9.02 | $12.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.67 / $26.87 / $42.26
| Professional | | $23.67 | $26.87 | $42.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.99 / $11.40 / $16.18
| Professional | 26 | $8.99 | $11.40 | $16.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.67 / $15.47 / $24.59
| Professional | TC | $14.67 | $15.47 | $24.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.47 / $23.98 / $36.67
| Professional | | $8.47 | $23.98 | $36.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $36.18 / $64.30
| Professional | | $26.00 | $36.18 | $64.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $11.42 / $18.75
| Professional | 26 | $7.95 | $11.42 | $18.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.78 / $22.63 / $45.69
| Professional | TC | $16.78 | $22.63 | $45.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.66 / $31.04 / $55.29
| Professional | | $24.66 | $31.04 | $55.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.03 / $9.38 / $16.21
| Professional | 26 | $8.03 | $9.38 | $16.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.32 / $21.48 / $38.99
| Professional | TC | $16.32 | $21.48 | $38.99 |