- 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
- $40.74 / $60.26 / $128.82
| Professional | | $40.74 | $60.26 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $15.85 / $54.95
| Professional | 26 | $10.47 | $15.85 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $39.81 / $75.86
| Professional | TC | $30.20 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $39.81 / $60.26
| Professional | | $33.11 | $39.81 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $10.96 / $18.20
| Professional | 26 | $9.55 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $33.11 / $42.66
| Professional | TC | $26.30 | $33.11 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $63.10 / $77.62
| Professional | | $53.70 | $63.10 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $17.38 / $22.39
| Professional | 26 | $13.80 | $17.38 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $46.77 / $52.48
| Professional | TC | $39.81 | $46.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $29.51 / $29.51
| Professional | 26 | $12.59 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $50.12 / $97.72
| Professional | | $33.11 | $50.12 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $15.14 / $28.18
| Professional | 26 | $8.71 | $15.14 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $35.48 / $67.61
| Professional | TC | $23.44 | $35.48 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $48.98 / $79.43
| Professional | | $36.31 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $13.80 / $23.44
| Professional | 26 | $10.96 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $34.67 / $53.70
| Professional | TC | $25.12 | $34.67 | $53.70 |