- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.45 / $34.54 / $50.37
| Facility | 26 | $17.45 | $34.54 | $50.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $44.28 / $89.12
| Professional | | $31.92 | $44.28 | $89.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $11.89 / $27.58
| Professional | 26 | $10.02 | $11.89 | $27.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.13 / $31.21 / $61.04
| Professional | TC | $23.13 | $31.21 | $61.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $44.28 / $46.05
| Professional | | $40.74 | $44.28 | $46.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.42 / $14.35 / $28.25
| Professional | 26 | $9.42 | $14.35 | $28.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.60 / $40.68 / $50.85
| Professional | | $35.60 | $40.68 | $50.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $9.84 / $12.92
| Professional | 26 | $8.61 | $9.84 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.99 / $30.84 / $38.54
| Professional | TC | $26.99 | $30.84 | $38.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $14.26 / $14.26
| Facility | 26 | $14.26 | $14.26 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.22 / $53.77 / $87.16
| Professional | | $38.22 | $53.77 | $87.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.51 / $15.11 / $26.28
| Professional | 26 | $10.51 | $15.11 | $26.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.31 / $36.64 / $60.89
| Professional | TC | $27.31 | $36.64 | $60.89 |
- 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
- $41.30 / $46.56 / $306.22
| Professional | | $41.30 | $46.56 | $306.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.97 / $13.71 / $95.76
| Professional | 26 | $11.97 | $13.71 | $95.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.03 / $33.32 / $250.00
| Professional | TC | $28.03 | $33.32 | $250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.04 / $46.56 / $75.39
| Professional | | $41.04 | $46.56 | $75.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.97 / $13.71 / $23.04
| Professional | 26 | $11.97 | $13.71 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.92 / $32.85 / $52.86
| Professional | TC | $27.92 | $32.85 | $52.86 |