- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.02 / $35.69 / $48.45
| Facility | 26 | $16.02 | $35.69 | $48.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.44 / $50.47 / $135.77
| Professional | | $36.44 | $50.47 | $135.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.52 / $11.28 / $23.34
| Professional | 26 | $9.52 | $11.28 | $23.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.89 / $37.56 / $72.16
| Professional | TC | $27.89 | $37.56 | $72.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.65 / $8.65 / $13.19
| Professional | 26 | $8.65 | $8.65 | $13.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.67 / $46.48 / $58.10
| Professional | | $40.67 | $46.48 | $58.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.91 / $9.03 / $11.30
| Professional | 26 | $7.91 | $9.03 | $11.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.76 / $37.44 / $46.80
| Professional | TC | $32.76 | $37.44 | $46.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.10 / $13.10 / $13.10
| Facility | 26 | $13.10 | $13.10 | $13.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.55 / $58.52 / $98.10
| Professional | | $42.55 | $58.52 | $98.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.66 / $14.16 / $24.88
| Professional | 26 | $9.66 | $14.16 | $24.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.74 / $43.08 / $73.20
| Professional | TC | $31.74 | $43.08 | $73.20 |
- 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
- $45.51 / $52.33 / $345.31
| Professional | | $45.51 | $52.33 | $345.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.23 / $12.89 / $142.00
| Professional | 26 | $11.23 | $12.89 | $142.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.74 / $39.99 / $272.83
| Professional | TC | $33.74 | $39.99 | $272.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.28 / $52.33 / $88.57
| Professional | | $44.28 | $52.33 | $88.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.03 / $12.63 / $21.61
| Professional | 26 | $11.03 | $12.63 | $21.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.47 / $39.70 / $63.52
| Professional | TC | $33.47 | $39.70 | $63.52 |