- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.28 / $10.28 / $16.02
| Facility | 26 | $10.28 | $10.28 | $16.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.95 / $32.14 / $45.32
| Professional | | $26.95 | $32.14 | $45.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $9.58 / $28.48
| Professional | 26 | $8.34 | $9.58 | $28.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.19 / $23.10 / $65.70
| Professional | TC | $20.19 | $23.10 | $65.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.75 / $81.14 / $85.10
| Professional | | $65.75 | $81.14 | $85.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.41 / $22.72 / $23.75
| Professional | 26 | $18.41 | $22.72 | $23.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.34 / $58.42 / $61.27
| Professional | TC | $47.34 | $58.42 | $61.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.88 / $58.59 / $83.13
| Professional | | $34.88 | $58.59 | $83.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $17.13 / $23.95
| Professional | 26 | $9.94 | $17.13 | $23.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.74 / $38.82 / $57.05
| Professional | TC | $23.74 | $38.82 | $57.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.28 / $59.76 / $217.42
| Professional | | $32.28 | $59.76 | $217.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.03 / $19.48 / $72.64
| Professional | 26 | $10.03 | $19.48 | $72.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.59 / $39.01 / $199.00
| Professional | TC | $21.59 | $39.01 | $199.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $58.92 / $82.47
| Professional | | $33.20 | $58.92 | $82.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.38 / $18.45 / $25.64
| Professional | 26 | $10.38 | $18.45 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.73 / $38.42 / $50.14
| Professional | TC | $22.73 | $38.42 | $50.14 |