- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $13.80 / $18.20
| Facility | 26 | $12.02 | $13.80 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $41.69 / $77.62
| Professional | | $30.20 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.88 / $26.30
| Professional | 26 | $7.94 | $12.88 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $28.84 / $52.48
| Professional | TC | $19.95 | $28.84 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $31.62 / $41.69
| Professional | | $29.51 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.00 / $15.14
| Professional | 26 | $7.94 | $10.00 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $26.30 / $47.86
| Professional | TC | $18.20 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $47.86 / $56.23
| Professional | | $40.74 | $47.86 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $14.13 / $17.38
| Professional | 26 | $11.75 | $14.13 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $33.88 / $38.02
| Professional | TC | $28.84 | $33.88 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $23.44 / $23.44
| Professional | 26 | $10.23 | $23.44 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $36.31 / $69.18
| Professional | | $23.44 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $10.96 / $19.95
| Professional | 26 | $6.76 | $10.96 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $26.30 / $50.12
| Professional | TC | $16.98 | $26.30 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $37.15 / $57.54
| Professional | | $26.30 | $37.15 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $11.22 / $16.60
| Professional | 26 | $7.94 | $11.22 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $25.70 / $39.81
| Professional | TC | $18.62 | $25.70 | $39.81 |