- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.89 / $17.39 / $17.39
| Facility | 26 | $12.89 | $17.39 | $17.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.33 / $31.75 / $43.82
| Professional | | $21.33 | $31.75 | $43.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.44 / $8.42 / $12.89
| Professional | 26 | $6.44 | $8.42 | $12.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.90 / $23.57 / $30.93
| Professional | TC | $14.90 | $23.57 | $30.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.28 / $28.28 / $28.28
| Professional | | $28.28 | $28.28 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $8.52 / $12.62
| Professional | 26 | $7.78 | $8.52 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.65 / $39.50 / $46.61
| Professional | | $27.65 | $39.50 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.85 / $8.02 / $9.46
| Professional | 26 | $5.85 | $8.02 | $9.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.04 / $31.48 / $37.15
| Professional | TC | $22.04 | $31.48 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $37.69 / $74.84
| Professional | | $19.95 | $37.69 | $74.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.96 / $10.07 / $20.46
| Professional | 26 | $6.96 | $10.07 | $20.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.85 / $27.12 / $58.69
| Professional | TC | $16.85 | $27.12 | $58.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.30 / $25.72 / $52.17
| Professional | | $20.30 | $25.72 | $52.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.69 / $7.58 / $11.09
| Professional | 26 | $5.69 | $7.58 | $11.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.61 / $19.05 / $42.30
| Professional | TC | $14.61 | $19.05 | $42.30 |