- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.82 / $10.00 / $12.06
| Facility | 26 | $9.82 | $10.00 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.80 / $39.92 / $68.45
| Professional | | $26.80 | $39.92 | $68.45 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $47.07 / $47.07 / $47.07
| Professional | 25 | $47.07 | $47.07 | $47.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.64 / $9.82 / $33.00
| Professional | 26 | $7.64 | $9.82 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.52 / $29.54 / $37.33
| Professional | TC | $17.52 | $29.54 | $37.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $25.36 / $42.31
| Professional | | $21.26 | $25.36 | $42.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $8.84 / $13.55
| Professional | 26 | $7.44 | $8.84 | $13.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.51 / $34.71 / $58.74
| Professional | | $28.51 | $34.71 | $58.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.48 / $9.61 / $14.08
| Professional | 26 | $8.48 | $9.61 | $14.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.60 / $23.86 / $43.61
| Professional | TC | $19.60 | $23.86 | $43.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.24 / $11.38 / $11.38
| Professional | 26 | $8.24 | $11.38 | $11.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $9.25 / $9.25
| Facility | 26 | $9.25 | $9.25 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.70 / $36.13 / $62.23
| Professional | | $27.70 | $36.13 | $62.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.27 / $10.54 / $16.91
| Professional | 26 | $8.27 | $10.54 | $16.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.78 / $25.89 / $46.91
| Professional | TC | $18.78 | $25.89 | $46.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $35.01 / $58.05
| Professional | | $27.54 | $35.01 | $58.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.93 / $8.66 / $14.22
| Professional | 26 | $6.93 | $8.66 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.57 / $26.14 / $41.98
| Professional | TC | $20.57 | $26.14 | $41.98 |