- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.19 / $18.16 / $38.09
| Facility | 26 | $13.19 | $18.16 | $38.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.73 / $34.42 / $96.35
| Professional | | $25.73 | $34.42 | $96.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.68 / $9.11 / $20.91
| Professional | 26 | $7.68 | $9.11 | $20.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.09 / $23.11 / $43.59
| Professional | TC | $16.09 | $23.11 | $43.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.91 / $29.09 / $33.58
| Professional | | $24.91 | $29.09 | $33.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.13 / $7.16 / $17.38
| Professional | 26 | $7.13 | $7.16 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.36 / $28.98 / $36.22
| Professional | | $25.36 | $28.98 | $36.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.51 / $7.44 / $9.30
| Professional | 26 | $6.51 | $7.44 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.85 / $21.54 / $26.93
| Professional | TC | $18.85 | $21.54 | $26.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $40.67 / $64.89
| Professional | | $27.86 | $40.67 | $64.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $11.77 / $20.04
| Professional | 26 | $7.95 | $11.77 | $20.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $27.39 / $45.14
| Professional | TC | $19.05 | $27.39 | $45.14 |
- 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
- $30.72 / $34.49 / $217.42
| Professional | | $30.72 | $34.49 | $217.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.49 / $10.47 / $72.64
| Professional | 26 | $9.49 | $10.47 | $72.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.08 / $24.64 / $199.00
| Professional | TC | $21.08 | $24.64 | $199.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.60 / $33.20 / $54.00
| Professional | | $30.60 | $33.20 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.36 / $10.47 / $19.20
| Professional | 26 | $9.36 | $10.47 | $19.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.46 / $22.75 / $37.20
| Professional | TC | $20.46 | $22.75 | $37.20 |