- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $9.33 / $16.98
| Facility | 26 | $9.33 | $9.33 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $42.66 / $77.62
| Professional | | $33.11 | $42.66 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $10.96 / $25.12
| Professional | 26 | $8.91 | $10.96 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $30.20 / $54.95
| Professional | TC | $22.91 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $51.29 / $85.11
| Professional | | $25.12 | $51.29 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $11.22 / $25.12
| Professional | 26 | $8.32 | $11.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $25.70 / $39.81
| Professional | TC | $23.99 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Professional | | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $56.23 / $83.18
| Professional | | $28.84 | $56.23 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $15.49 / $22.91
| Professional | 26 | $8.71 | $15.49 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $40.74 / $61.66
| Professional | TC | $22.91 | $40.74 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $32.36 / $33.11
| Professional | | $22.39 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $42.66 / $79.43
| Professional | | $33.11 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $11.75 / $22.39
| Professional | 26 | $9.12 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $29.51 / $60.26
| Professional | TC | $23.44 | $29.51 | $60.26 |