- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.86 / $25.98 / $54.45
| Facility | 26 | $18.86 | $25.98 | $54.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.42 / $45.59 / $85.17
| Professional | | $32.42 | $45.59 | $85.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.52 / $13.00 / $26.55
| Professional | 26 | $10.52 | $13.00 | $26.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.13 / $31.57 / $59.42
| Professional | TC | $23.13 | $31.57 | $59.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.19 / $57.19 / $57.19
| Professional | | $57.19 | $57.19 | $57.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.18 / $10.18 / $10.18
| Professional | 26 | $10.18 | $10.18 | $10.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.29 / $41.48 / $51.85
| Professional | | $36.29 | $41.48 | $51.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.31 / $10.64 / $13.97
| Professional | 26 | $9.31 | $10.64 | $13.97 |
- 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
- $15.41 / $15.41 / $15.41
| Facility | 26 | $15.41 | $15.41 | $15.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.88 / $54.96 / $89.93
| Professional | | $38.88 | $54.96 | $89.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.36 / $16.27 / $28.35
| Professional | 26 | $11.36 | $16.27 | $28.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.28 / $36.68 / $61.57
| Professional | TC | $27.28 | $36.68 | $61.57 |
- 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
- $42.25 / $47.28 / $438.00
| Professional | | $42.25 | $47.28 | $438.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.95 / $14.44 / $97.41
| Professional | 26 | $12.95 | $14.44 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.35 / $33.32 / $423.00
| Professional | TC | $28.35 | $33.32 | $423.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.25 / $47.28 / $84.95
| Professional | | $42.25 | $47.28 | $84.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.92 / $14.44 / $26.48
| Professional | 26 | $12.92 | $14.44 | $26.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.22 / $32.84 / $60.22
| Professional | TC | $28.22 | $32.84 | $60.22 |