- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $15.85 / $20.89
| Facility | 26 | $14.13 | $15.85 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $48.98 / $89.13
| Professional | | $33.88 | $48.98 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.22 / $38.02
| Professional | 26 | $10.00 | $16.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $28.84 / $51.29
| Professional | TC | $20.42 | $28.84 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $29.51 / $45.71
| Professional | | $28.18 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $12.30 / $15.49
| Professional | 26 | $8.71 | $12.30 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $25.12 / $26.92
| Professional | TC | $25.12 | $25.12 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $52.48 / $61.66
| Professional | | $44.67 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $16.22 / $21.38
| Professional | 26 | $13.80 | $16.22 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $36.31 / $40.74
| Professional | TC | $30.90 | $36.31 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $12.59 / $39.81
| Professional | 26 | $11.75 | $12.59 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $39.81 / $74.13
| Professional | | $26.92 | $39.81 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $14.13 / $25.12
| Professional | 26 | $8.71 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $28.18 / $52.48
| Professional | TC | $17.78 | $28.18 | $52.48 |
- 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 / $13.80 / $20.89
| Professional | 26 | $10.72 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $26.92 / $42.66
| Professional | TC | $19.05 | $26.92 | $42.66 |