- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.62 / $26.97 / $39.33
| Facility | 26 | $13.62 | $26.97 | $39.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $30.43 / $57.93
| Professional | | $21.73 | $30.43 | $57.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.77 / $9.27 / $19.76
| Professional | 26 | $6.77 | $9.27 | $19.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.93 / $21.35 / $40.79
| Professional | TC | $14.93 | $21.35 | $40.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.04 / $22.48 / $30.35
| Professional | | $22.04 | $22.48 | $30.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.36 / $7.36 / $8.23
| Professional | 26 | $7.36 | $7.36 | $8.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.28 / $27.75 / $34.69
| Professional | | $24.28 | $27.75 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $7.70 / $9.63
| Professional | 26 | $6.74 | $7.70 | $9.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.54 / $20.05 / $25.06
| Professional | TC | $17.54 | $20.05 | $25.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.79 / $10.79 / $10.79
| Facility | 26 | $10.79 | $10.79 | $10.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $38.58 / $61.75
| Professional | | $27.05 | $38.58 | $61.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.22 / $11.42 / $20.32
| Professional | 26 | $8.22 | $11.42 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.02 / $25.55 / $41.72
| Professional | TC | $18.02 | $25.55 | $41.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.57 / $31.92 / $206.60
| Professional | | $29.57 | $31.92 | $206.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.10 / $10.74 / $78.44
| Professional | 26 | $9.10 | $10.74 | $78.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.38 / $22.73 / $193.00
| Professional | TC | $19.38 | $22.73 | $193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.40 / $31.76 / $53.95
| Professional | | $29.40 | $31.76 | $53.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.85 / $10.47 / $17.28
| Professional | 26 | $8.85 | $10.47 | $17.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.98 / $21.29 / $39.04
| Professional | TC | $18.98 | $21.29 | $39.04 |