- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.45 / $9.38 / $16.07
| Facility | 26 | $7.45 | $9.38 | $16.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.04 / $30.11 / $78.70
| Professional | | $21.04 | $30.11 | $78.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.86 / $8.22 / $25.50
| Professional | 26 | $6.86 | $8.22 | $25.50 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $55.17 / $91.21 / $91.64
| Professional | 50 | $55.17 | $91.21 | $91.64 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.99 / $13.82 / $18.28
| Professional | 52 | $10.99 | $13.82 | $18.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.34 / $21.27 / $46.40
| Professional | TC | $17.34 | $21.27 | $46.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.57 / $8.57 / $8.57
| Facility | 26 | $8.57 | $8.57 | $8.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.28 / $32.55 / $52.94
| Professional | | $25.28 | $32.55 | $52.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $10.48 / $15.51
| Professional | 26 | $7.44 | $10.48 | $15.51 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $36.64 / $46.11 / $76.29
| Professional | 50 | $36.64 | $46.11 | $76.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.99 / $23.79 / $38.78
| Professional | TC | $17.99 | $23.79 | $38.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $8.86 / $8.86
| Facility | 26 | $8.86 | $8.86 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.32 / $37.25 / $60.86
| Professional | | $24.32 | $37.25 | $60.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.97 / $11.07 / $17.73
| Professional | 26 | $6.97 | $11.07 | $17.73 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $35.13 / $35.13 / $39.76
| Professional | 50 | $35.13 | $35.13 | $39.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.61 / $25.97 / $44.66
| Professional | TC | $17.61 | $25.97 | $44.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $31.15 / $54.12
| Professional | | $25.65 | $31.15 | $54.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.39 / $9.52 / $16.48
| Professional | 26 | $7.39 | $9.52 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.72 / $22.22 / $39.04
| Professional | TC | $17.72 | $22.22 | $39.04 |