- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $16.60 / $19.05
| Facility | 26 | $14.13 | $16.60 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $42.66 / $102.33
| Professional | | $23.44 | $42.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $15.14 / $32.36
| Professional | 26 | $10.00 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $30.20 / $53.70
| Professional | TC | $21.88 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $31.62 / $39.81
| Professional | | $25.70 | $31.62 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $10.72 / $19.95
| Professional | 26 | $9.55 | $10.72 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $26.30 / $41.69
| Professional | TC | $17.78 | $26.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $61.66
| Professional | | $43.65 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $16.98 / $22.39
| Professional | 26 | $14.13 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $35.48 / $39.81
| Professional | TC | $30.20 | $35.48 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $25.12 / $25.12
| Professional | 26 | $12.59 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $39.81 / $77.62
| Professional | | $26.30 | $39.81 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $14.13 / $25.70
| Professional | 26 | $8.51 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $26.92 / $51.29
| Professional | TC | $17.78 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $41.69 / $63.10
| Professional | | $29.51 | $41.69 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $13.49 / $20.89
| Professional | 26 | $10.72 | $13.49 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $26.30 / $39.81
| Professional | TC | $19.05 | $26.30 | $39.81 |