- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $14.45 / $14.45
| Facility | 26 | $9.77 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $48.98 / $97.72
| Professional | | $28.18 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $16.22 / $27.54
| Professional | 26 | $7.94 | $16.22 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $30.20 / $63.10
| Professional | TC | $18.62 | $30.20 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $35.48 / $47.86
| Professional | | $29.51 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.96 / $15.14
| Professional | 26 | $7.94 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $27.54 / $38.90
| Professional | TC | $16.98 | $27.54 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $48.98 / $63.10
| Professional | | $34.67 | $48.98 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $15.49 / $18.20
| Professional | 26 | $10.72 | $15.49 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $33.88 / $42.66
| Professional | TC | $23.44 | $33.88 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $10.47 / $10.72
| Facility | 26 | $10.47 | $10.47 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $38.90 / $91.20
| Professional | | $25.70 | $38.90 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $12.59 / $26.92
| Professional | 26 | $8.71 | $12.59 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $30.20 / $67.61
| Professional | TC | $21.88 | $30.20 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $35.48 / $47.86
| Professional | | $25.70 | $35.48 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $11.22 / $14.45
| Professional | 26 | $7.94 | $11.22 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $24.55 / $34.67
| Professional | TC | $17.78 | $24.55 | $34.67 |