- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.61 / $32.54 / $44.17
| Facility | 26 | $14.61 | $32.54 | $44.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $37.67 / $77.89
| Professional | | $27.86 | $37.67 | $77.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.46 / $9.98 / $17.62
| Professional | 26 | $8.46 | $9.98 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.63 / $27.69 / $53.05
| Professional | TC | $20.63 | $27.69 | $53.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $35.78 / $35.78
| Professional | | $28.18 | $35.78 | $35.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.89 / $7.89 / $7.89
| Professional | 26 | $7.89 | $7.89 | $7.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.31 / $35.78 / $44.73
| Professional | | $31.31 | $35.78 | $44.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.21 / $8.24 / $10.82
| Professional | 26 | $7.21 | $8.24 | $10.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.10 / $27.54 / $34.43
| Professional | TC | $24.10 | $27.54 | $34.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.95 / $11.95 / $11.95
| Facility | 26 | $11.95 | $11.95 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $46.55 / $76.16
| Professional | | $33.21 | $46.55 | $76.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.80 / $12.74 / $22.12
| Professional | 26 | $8.80 | $12.74 | $22.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.19 / $32.46 / $54.04
| Professional | TC | $24.19 | $32.46 | $54.04 |
- 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
- $36.15 / $40.42 / $267.27
| Professional | | $36.15 | $40.42 | $267.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $11.55 / $85.85
| Professional | 26 | $10.23 | $11.55 | $85.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.81 / $29.60 / $244.00
| Professional | TC | $24.81 | $29.60 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.00 / $40.42 / $64.97
| Professional | | $36.00 | $40.42 | $64.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.08 / $11.55 / $19.46
| Professional | 26 | $10.08 | $11.55 | $19.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.77 / $28.87 / $47.27
| Professional | TC | $24.77 | $28.87 | $47.27 |