- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.56 / $3.75 / $9.30
| Facility | 26 | $3.56 | $3.75 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.07 / $30.39 / $43.75
| Professional | | $21.07 | $30.39 | $43.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.84 / $3.79 / $5.15
| Professional | 26 | $2.84 | $3.79 | $5.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $9.61 / $13.35 / $16.55
| Professional | 52 | $9.61 | $13.35 | $16.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.54 / $25.33 / $37.40
| Professional | TC | $17.54 | $25.33 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.42 / $32.42 / $32.42
| Professional | | $32.42 | $32.42 | $32.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.83 / $3.30 / $3.34
| Professional | 26 | $2.83 | $3.30 | $3.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $31.84 / $50.87
| Professional | | $29.13 | $31.84 | $50.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.09 / $4.47 / $7.14
| Professional | 26 | $4.09 | $4.47 | $7.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.05 / $27.49 / $43.73
| Professional | TC | $25.05 | $27.49 | $43.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.15 / $3.15 / $3.31
| Professional | 26 | $3.15 | $3.15 | $3.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.85 / $31.53 / $112.28
| Professional | | $21.85 | $31.53 | $112.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.12 / $4.26 / $6.67
| Professional | 26 | $3.12 | $4.26 | $6.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.48 / $27.26 / $93.01
| Professional | TC | $19.48 | $27.26 | $93.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.84 / $29.05 / $124.77
| Professional | | $20.84 | $29.05 | $124.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.76 / $3.67 / $5.95
| Professional | 26 | $2.76 | $3.67 | $5.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.72 / $24.90 / $94.71
| Professional | TC | $17.72 | $24.90 | $94.71 |