- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.07 / $33.56 / $45.56
| Facility | 26 | $15.07 | $33.56 | $45.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.19 / $48.89 / $116.25
| Professional | | $31.19 | $48.89 | $116.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.46 / $10.75 / $16.66
| Professional | 26 | $8.46 | $10.75 | $16.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.29 / $36.58 / $59.68
| Professional | TC | $23.29 | $36.58 | $59.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.38 / $26.38 / $26.38
| Professional | | $26.38 | $26.38 | $26.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.14 / $12.38 / $14.82
| Professional | 26 | $8.14 | $12.38 | $14.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.02 / $35.45 / $44.31
| Professional | | $31.02 | $35.45 | $44.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $8.50 / $10.63
| Professional | 26 | $7.44 | $8.50 | $10.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.58 / $26.94 / $33.68
| Professional | TC | $23.58 | $26.94 | $33.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $12.30 / $12.30
| Facility | 26 | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.01 / $53.89 / $85.37
| Professional | | $34.01 | $53.89 | $85.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.08 / $13.25 / $23.25
| Professional | 26 | $9.08 | $13.25 | $23.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.93 / $40.24 / $64.04
| Professional | TC | $24.93 | $40.24 | $64.04 |
- 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
- $40.06 / $48.13 / $262.94
| Professional | | $40.06 | $48.13 | $262.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $11.91 / $117.24
| Professional | 26 | $10.23 | $11.91 | $117.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.51 / $36.86 / $201.73
| Professional | TC | $28.51 | $36.86 | $201.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $44.93 / $75.81
| Professional | | $40.06 | $44.93 | $75.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $11.55 / $21.18
| Professional | 26 | $10.23 | $11.55 | $21.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.51 / $33.85 / $61.17
| Professional | TC | $28.51 | $33.85 | $61.17 |