- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.85 / $12.17 / $15.80
| Facility | 26 | $9.85 | $12.17 | $15.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.89 / $46.43 / $97.90
| Professional | | $30.89 | $46.43 | $97.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.11 / $11.03 / $16.75
| Professional | 26 | $8.11 | $11.03 | $16.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.03 / $33.28 / $87.98
| Professional | TC | $23.03 | $33.28 | $87.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.46 / $36.25 / $38.85
| Professional | | $34.46 | $36.25 | $38.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $9.86 / $17.38
| Professional | 26 | $7.03 | $9.86 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.88 / $45.88 / $45.88
| Professional | TC | $45.88 | $45.88 | $45.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.39 / $53.43 / $87.69
| Professional | | $44.39 | $53.43 | $87.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.06 / $14.46 / $18.70
| Professional | 26 | $11.06 | $14.46 | $18.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.32 / $38.10 / $68.98
| Professional | TC | $33.32 | $38.10 | $68.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.56 / $9.25 / $35.28
| Professional | 26 | $8.56 | $9.25 | $35.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $41.04 / $102.42
| Professional | | $22.92 | $41.04 | $102.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.84 / $10.28 / $18.27
| Professional | 26 | $5.84 | $10.28 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.05 / $28.63 / $63.26
| Professional | TC | $17.05 | $28.63 | $63.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.00 / $45.23 / $118.21
| Professional | | $29.00 | $45.23 | $118.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.04 / $10.78 / $18.27
| Professional | 26 | $7.04 | $10.78 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.62 / $32.99 / $70.08
| Professional | TC | $21.62 | $32.99 | $70.08 |