- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.50 / $10.62 / $17.98
| Facility | 26 | $8.50 | $10.62 | $17.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.20 / $30.53 / $63.00
| Professional | | $20.20 | $30.53 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.58 / $8.89 / $19.69
| Professional | 26 | $7.58 | $8.89 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $54.58 / $61.24 / $113.57
| Professional | 50 | $54.58 | $61.24 | $113.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.00 / $19.46 / $33.32
| Professional | TC | $13.00 | $19.46 | $33.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.66 / $9.66 / $9.66
| Facility | 26 | $9.66 | $9.66 | $9.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.29 / $32.42 / $49.57
| Professional | | $23.29 | $32.42 | $49.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.41 / $11.40 / $17.54
| Professional | 26 | $8.41 | $11.40 | $17.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $34.38 / $44.08 / $72.04
| Professional | 50 | $34.38 | $44.08 | $72.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.88 / $21.52 / $32.36
| Professional | TC | $14.88 | $21.52 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.96 / $9.96 / $9.96
| Facility | 26 | $9.96 | $9.96 | $9.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.48 / $36.22 / $59.77
| Professional | | $24.48 | $36.22 | $59.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.87 / $12.38 / $20.04
| Professional | 26 | $7.87 | $12.38 | $20.04 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $41.47 / $41.47 / $47.09
| Professional | 50 | $41.47 | $41.47 | $47.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.11 / $24.29 / $42.03
| Professional | TC | $16.11 | $24.29 | $42.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.60 / $32.38 / $54.19
| Professional | | $25.60 | $32.38 | $54.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.14 / $10.55 / $18.29
| Professional | 26 | $8.14 | $10.55 | $18.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.84 / $22.51 / $37.83
| Professional | TC | $16.84 | $22.51 | $37.83 |