- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.57 / $16.19 / $33.93
| Facility | 26 | $9.57 | $16.19 | $33.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.48 / $36.68 / $141.75
| Professional | | $28.48 | $36.68 | $141.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.32 / $18.25
| Professional | 26 | $6.98 | $8.32 | $18.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.51 / $27.03 / $51.69
| Professional | TC | $21.51 | $27.03 | $51.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $35.70 / $38.22
| Professional | | $28.02 | $35.70 | $38.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.35 / $9.63 / $19.05
| Professional | 26 | $6.35 | $9.63 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.86 / $32.97 / $41.23
| Professional | | $28.86 | $32.97 | $41.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.80 / $6.63 / $8.28
| Professional | 26 | $5.80 | $6.63 | $8.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.06 / $26.35 / $32.94
| Professional | TC | $23.06 | $26.35 | $32.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.18 / $40.39 / $67.34
| Professional | | $29.18 | $40.39 | $67.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.08 / $17.27
| Professional | 26 | $7.08 | $10.08 | $17.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.14 / $29.26 / $50.54
| Professional | TC | $21.14 | $29.26 | $50.54 |
- 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
- $30.45 / $36.81 / $245.68
| Professional | | $30.45 | $36.81 | $245.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.14 / $9.02 / $61.09
| Professional | 26 | $8.14 | $9.02 | $61.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.68 / $27.79 / $192.57
| Professional | TC | $22.68 | $27.79 | $192.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.52 / $36.81 / $59.04
| Professional | | $29.52 | $36.81 | $59.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.09 / $9.02 / $15.84
| Professional | 26 | $8.09 | $9.02 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.20 / $27.79 / $44.46
| Professional | TC | $22.20 | $27.79 | $44.46 |