- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.65 / $9.76 / $14.69
| Facility | 26 | $7.65 | $9.76 | $14.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.14 / $36.15 / $86.79
| Professional | | $24.14 | $36.15 | $86.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.35 / $8.94 / $10.92
| Professional | 26 | $6.35 | $8.94 | $10.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.79 / $27.03 / $77.39
| Professional | TC | $17.79 | $27.03 | $77.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $34.65 / $57.97
| Professional | | $34.65 | $34.65 | $57.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.00 / $8.75 / $15.94
| Professional | 26 | $7.00 | $8.75 | $15.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.68 / $33.68 / $33.68
| Professional | TC | $33.68 | $33.68 | $33.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $35.00 / $48.06
| Professional | | $9.44 | $35.00 | $48.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.11 / $9.11 / $14.82
| Facility | 26 | $9.11 | $9.11 | $14.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.93 / $56.42 / $123.93
| Professional | | $32.93 | $56.42 | $123.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.30 / $9.78 / $16.13
| Professional | 26 | $8.30 | $9.78 | $16.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.62 / $42.87 / $105.77
| Professional | TC | $24.62 | $42.87 | $105.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.20 / $80.00 / $80.00
| Facility | 26 | $39.20 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $50.88 / $539.95
| Professional | | $34.04 | $50.88 | $539.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $10.11 / $97.55
| Professional | 26 | $7.59 | $10.11 | $97.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.96 / $43.20 / $492.53
| Professional | TC | $23.96 | $43.20 | $492.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $44.07 / $97.29
| Professional | | $32.04 | $44.07 | $97.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.48 / $9.77 / $17.28
| Professional | 26 | $7.48 | $9.77 | $17.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.87 / $32.34 / $69.13
| Professional | TC | $22.87 | $32.34 | $69.13 |