- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $33.59 / $48.97
| Facility | 26 | $13.80 | $33.59 | $48.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.17 / $43.45 / $87.58
| Professional | | $32.17 | $43.45 | $87.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.88 / $10.93 / $23.87
| Professional | 26 | $8.88 | $10.93 | $23.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.29 / $31.92 / $58.81
| Professional | TC | $23.29 | $31.92 | $58.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.04 / $39.86 / $41.85
| Professional | | $35.04 | $39.86 | $41.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.05 / $9.22 / $9.27
| Professional | 26 | $9.05 | $9.22 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.95 / $36.51 / $45.64
| Professional | | $31.95 | $36.51 | $45.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.36 / $9.57 / $11.96
| Professional | 26 | $8.36 | $9.57 | $11.96 |
- 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
- $13.86 / $13.86 / $13.86
| Facility | 26 | $13.86 | $13.86 | $13.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.63 / $48.89 / $83.71
| Professional | | $34.63 | $48.89 | $83.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $13.14 / $23.38
| Professional | 26 | $9.33 | $13.14 | $23.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.19 / $33.84 / $60.89
| Professional | TC | $25.19 | $33.84 | $60.89 |
- 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
- $37.74 / $43.86 / $271.52
| Professional | | $37.74 | $43.86 | $271.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.85 / $12.99 / $97.41
| Professional | 26 | $9.85 | $12.99 | $97.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.21 / $31.04 / $210.00
| Professional | TC | $27.21 | $31.04 | $210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.72 / $41.14 / $75.44
| Professional | | $36.72 | $41.14 | $75.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.85 / $12.99 / $19.07
| Professional | 26 | $9.85 | $12.99 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.95 / $28.88 / $51.62
| Professional | TC | $26.95 | $28.88 | $51.62 |