- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $4.01 / $16.17 / $31.29
| Facility | 26 | $4.01 | $16.17 | $31.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.09 / $37.53 / $72.44
| Professional | | $29.09 | $37.53 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.67 / $8.90 / $17.64
| Professional | 26 | $6.67 | $8.90 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $39.24 / $39.24 / $59.06
| Professional | 50 | $39.24 | $39.24 | $59.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.21 / $26.97 / $54.79
| Professional | TC | $21.21 | $26.97 | $54.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.48 / $34.86 / $39.42
| Professional | | $27.48 | $34.86 | $39.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.34 / $7.97 / $19.02
| Professional | 26 | $6.34 | $7.97 | $19.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.70 / $35.08 / $43.85
| Professional | | $30.70 | $35.08 | $43.85 |
- 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
- $24.89 / $28.45 / $35.56
| Professional | TC | $24.89 | $28.45 | $35.56 |
- 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
- $29.06 / $42.31 / $72.05
| Professional | | $29.06 | $42.31 | $72.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.07 / $10.41 / $18.36
| Professional | 26 | $7.07 | $10.41 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.77 / $31.15 / $56.17
| Professional | TC | $20.77 | $31.15 | $56.17 |
- 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
- $29.56 / $39.34 / $260.95
| Professional | | $29.56 | $39.34 | $260.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $9.69 / $83.63
| Professional | 26 | $8.34 | $9.69 | $83.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.55 / $30.32 / $207.72
| Professional | TC | $20.55 | $30.32 | $207.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $39.34 / $65.98
| Professional | | $29.51 | $39.34 | $65.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.14 / $9.08 / $16.97
| Professional | 26 | $8.14 | $9.08 | $16.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.67 / $30.32 / $57.05
| Professional | TC | $20.67 | $30.32 | $57.05 |