- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $19.05 / $24.55
| Facility | 26 | $16.98 | $19.05 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $47.86 / $316.23
| Facility | TC | $30.20 | $47.86 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $43.65 / $81.28
| Professional | | $33.11 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.14 / $44.67
| Professional | 26 | $12.02 | $15.14 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $28.84 / $44.67
| Professional | TC | $20.89 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $50.12
| Professional | | $33.88 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $15.14 / $16.22
| Professional | 26 | $15.14 | $15.14 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $56.23 / $66.07
| Professional | | $47.86 | $56.23 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $19.50 / $25.70
| Professional | 26 | $15.85 | $19.50 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $37.15 / $41.69
| Professional | TC | $31.62 | $37.15 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $28.84 / $28.84
| Facility | TC | $28.18 | $28.84 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $14.45 / $14.45
| Professional | 26 | $13.80 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $42.66 / $79.43
| Professional | | $28.84 | $42.66 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $16.60 / $29.51
| Professional | 26 | $10.23 | $16.60 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $28.18 / $52.48
| Professional | TC | $18.20 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $44.67 / $67.61
| Professional | | $32.36 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $16.60 / $25.12
| Professional | 26 | $12.88 | $16.60 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $27.54 / $43.65
| Professional | TC | $19.50 | $27.54 | $43.65 |