- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.24 / $16.86 / $35.33
| Facility | 26 | $12.24 | $16.86 | $35.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.74 / $29.66 / $107.74
| Professional | | $23.74 | $29.66 | $107.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.55 / $34.86
| Professional | 26 | $6.98 | $8.55 | $34.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.76 / $20.04 / $41.23
| Professional | TC | $16.76 | $20.04 | $41.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.57 / $27.33 / $30.90
| Professional | | $21.57 | $27.33 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $10.03 / $15.36
| Professional | 26 | $6.74 | $10.03 | $15.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.85 / $27.26 / $34.07
| Professional | | $23.85 | $27.26 | $34.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.04 / $6.90 / $9.06
| Professional | 26 | $6.04 | $6.90 | $9.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.80 / $20.35 / $25.44
| Professional | TC | $17.80 | $20.35 | $25.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.79 / $32.61 / $56.25
| Professional | | $24.79 | $32.61 | $56.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.31 / $10.06 / $17.27
| Professional | 26 | $7.31 | $10.06 | $17.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.86 / $23.13 / $40.34
| Professional | TC | $16.86 | $23.13 | $40.34 |
- 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
- $25.90 / $31.04 / $202.27
| Professional | | $25.90 | $31.04 | $202.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.16 / $9.38 / $111.75
| Professional | 26 | $8.16 | $9.38 | $111.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.00 / $21.66 / $146.99
| Professional | TC | $18.00 | $21.66 | $146.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.20 / $31.04 / $51.36
| Professional | | $25.20 | $31.04 | $51.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.07 / $9.36 / $15.60
| Professional | 26 | $8.07 | $9.36 | $15.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.50 / $21.66 / $39.72
| Professional | TC | $17.50 | $21.66 | $39.72 |