- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.07 / $18.37 / $27.02
| Facility | 26 | $17.07 | $18.37 | $27.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.59 / $43.52 / $75.03
| Professional | | $35.59 | $43.52 | $75.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.13 / $15.45 / $24.93
| Professional | 26 | $13.13 | $15.45 | $24.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.15 / $26.45 / $43.20
| Professional | TC | $22.15 | $26.45 | $43.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $41.61 / $46.91
| Professional | | $36.31 | $41.61 | $46.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.67 / $16.01 / $25.29
| Professional | 26 | $13.67 | $16.01 | $25.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.29 / $44.23 / $63.05
| Professional | | $37.29 | $44.23 | $63.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.80 / $16.87 / $24.72
| Professional | 26 | $14.80 | $16.87 | $24.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.89 / $27.49 / $38.72
| Professional | TC | $22.89 | $27.49 | $38.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.20 / $47.46 / $47.46
| Professional | 26 | $14.20 | $47.46 | $47.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.25 / $16.25 / $16.25
| Facility | 26 | $16.25 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.46 / $45.79 / $73.73
| Professional | | $37.46 | $45.79 | $73.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.51 / $18.43 / $29.52
| Professional | 26 | $14.51 | $18.43 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.11 / $28.05 / $43.22
| Professional | TC | $23.11 | $28.05 | $43.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.51 / $38.51 / $63.22
| Professional | | $30.51 | $38.51 | $63.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.09 / $15.12 / $25.64
| Professional | 26 | $12.09 | $15.12 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.45 / $23.40 / $37.58
| Professional | TC | $18.45 | $23.40 | $37.58 |