- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.50 / $30.61 / $40.81
| Facility | 26 | $11.50 | $30.61 | $40.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.20 / $37.67 / $101.97
| Professional | | $29.20 | $37.67 | $101.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.18 / $10.75 / $24.56
| Professional | 26 | $8.18 | $10.75 | $24.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.10 / $25.92 / $48.90
| Professional | TC | $19.10 | $25.92 | $48.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.86 / $32.89 / $47.73
| Professional | | $23.86 | $32.89 | $47.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $16.59 / $16.59
| Professional | 26 | $9.30 | $16.59 | $16.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.36 / $30.12 / $37.65
| Professional | | $26.36 | $30.12 | $37.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.97 / $7.97 / $9.96
| Professional | 26 | $6.97 | $7.97 | $9.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.38 / $22.15 / $27.69
| Professional | TC | $19.38 | $22.15 | $27.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.56 / $11.56 / $11.56
| Facility | 26 | $11.56 | $11.56 | $11.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.01 / $42.46 / $70.47
| Professional | | $29.01 | $42.46 | $70.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $12.96 / $22.87
| Professional | 26 | $8.51 | $12.96 | $22.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.50 / $28.97 / $48.24
| Professional | TC | $20.50 | $28.97 | $48.24 |
- 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
- $32.68 / $37.44 / $223.92
| Professional | | $32.68 | $37.44 | $223.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.17 / $11.57 / $92.47
| Professional | 26 | $10.17 | $11.57 | $92.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.44 / $25.81 / $211.00
| Professional | TC | $22.44 | $25.81 | $211.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.29 / $35.57 / $73.80
| Professional | | $32.29 | $35.57 | $73.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.72 / $11.19 / $19.55
| Professional | 26 | $9.72 | $11.19 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.56 / $24.70 / $39.59
| Professional | TC | $21.56 | $24.70 | $39.59 |