- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.30 / $27.33 / $34.15
| Facility | 26 | $11.30 | $27.33 | $34.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $29.83 / $81.20
| Professional | | $25.00 | $29.83 | $81.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.64 / $7.78 / $17.98
| Professional | 26 | $6.64 | $7.78 | $17.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.54 / $22.05 / $44.49
| Professional | TC | $16.54 | $22.05 | $44.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $29.36 / $33.19
| Professional | | $23.16 | $29.36 | $33.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.63 / $9.63 / $19.05
| Professional | 26 | $9.63 | $9.63 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.71 / $29.38 / $36.72
| Professional | | $25.71 | $29.38 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.80 / $6.63 / $8.28
| Professional | 26 | $5.80 | $6.63 | $8.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.91 / $22.75 / $28.44
| Professional | TC | $19.91 | $22.75 | $28.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $37.04 / $60.36
| Professional | | $25.82 | $37.04 | $60.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.81 / $10.06 / $17.27
| Professional | 26 | $6.81 | $10.06 | $17.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.77 / $25.49 / $43.51
| Professional | TC | $18.77 | $25.49 | $43.51 |
- 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
- $28.39 / $32.67 / $210.99
| Professional | | $28.39 | $32.67 | $210.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $9.02 / $82.56
| Professional | 26 | $8.13 | $9.02 | $82.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.69 / $23.65 / $159.97
| Professional | TC | $19.69 | $23.65 | $159.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.72 / $32.47 / $55.45
| Professional | | $27.72 | $32.47 | $55.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.07 / $9.02 / $15.85
| Professional | 26 | $8.07 | $9.02 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.69 / $23.46 / $38.13
| Professional | TC | $19.69 | $23.46 | $38.13 |