- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.91 / $10.91 / $14.74
| Facility | 26 | $10.91 | $10.91 | $14.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.84 / $58.97 / $90.99
| Professional | | $47.84 | $58.97 | $90.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.66 / $9.07 / $14.74
| Professional | 26 | $7.66 | $9.07 | $14.74 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $24.34 / $29.22 / $34.09
| Professional | 52 | $24.34 | $29.22 | $34.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.84 / $49.55 / $75.91
| Professional | TC | $40.84 | $49.55 | $75.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.13 / $58.94 / $63.39
| Professional | | $47.13 | $58.94 | $63.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.02 / $9.66 / $12.08
| Professional | 26 | $8.02 | $9.66 | $12.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.76 / $53.76 / $53.76
| Professional | TC | $53.76 | $53.76 | $53.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.61 / $70.70 / $83.43
| Professional | | $51.61 | $70.70 | $83.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.21 / $12.61 / $14.88
| Professional | 26 | $9.21 | $12.61 | $14.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.41 / $58.09 / $68.55
| Professional | TC | $42.41 | $58.09 | $68.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.00 / $71.03 / $149.79
| Professional | | $52.00 | $71.03 | $149.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $11.61 / $23.03
| Professional | 26 | $8.90 | $11.61 | $23.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.35 / $59.41 / $126.76
| Professional | TC | $43.35 | $59.41 | $126.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.17 / $52.32 / $74.59
| Professional | | $40.17 | $52.32 | $74.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.57 / $8.90 / $12.19
| Professional | 26 | $6.57 | $8.90 | $12.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.60 / $43.77 / $62.51
| Professional | TC | $33.60 | $43.77 | $62.51 |