- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.05 / $29.06 / $60.78
| Facility | 26 | $21.05 | $29.06 | $60.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $71.53 / $114.23
| Professional | | $37.04 | $71.53 | $114.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $10.99 / $39.92
| Professional | 26 | $7.33 | $10.99 | $39.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.31 / $63.35 / $91.87
| Professional | TC | $23.31 | $63.35 | $91.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.40 / $42.40 / $42.40
| Professional | | $42.40 | $42.40 | $42.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.91 / $11.65 / $27.84
| Professional | 26 | $10.91 | $11.65 | $27.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.42 / $37.04 / $46.31
| Professional | | $32.42 | $37.04 | $46.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.42 / $11.90 / $14.88
| Professional | 26 | $10.42 | $11.90 | $14.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.00 / $25.14 / $31.43
| Professional | TC | $22.00 | $25.14 | $31.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.93 / $16.93 / $16.93
| Facility | 26 | $16.93 | $16.93 | $16.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.22 / $74.78 / $127.13
| Professional | | $36.22 | $74.78 | $127.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.93 / $12.94 / $27.34
| Professional | 26 | $7.93 | $12.94 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.27 / $55.41 / $104.27
| Professional | TC | $23.27 | $55.41 | $104.27 |
- 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
- $42.59 / $80.14 / $475.98
| Professional | | $42.59 | $80.14 | $475.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.96 / $15.88 / $211.35
| Professional | 26 | $7.96 | $15.88 | $211.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.71 / $59.62 / $429.40
| Professional | TC | $26.71 | $59.62 | $429.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.59 / $60.48 / $98.47
| Professional | | $42.59 | $60.48 | $98.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.96 / $15.12 / $23.32
| Professional | 26 | $7.96 | $15.12 | $23.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.71 / $44.56 / $86.56
| Professional | TC | $26.71 | $44.56 | $86.56 |