- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.28 / $45.16 / $61.31
| Facility | 26 | $20.28 | $45.16 | $61.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.17 / $54.56 / $103.77
| Professional | | $42.17 | $54.56 | $103.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.73 / $14.06 / $21.87
| Professional | 26 | $11.73 | $14.06 | $21.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.87 / $40.50 / $69.03
| Professional | TC | $29.87 | $40.50 | $69.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.29 / $47.12 / $247.80
| Professional | | $33.29 | $47.12 | $247.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.05 / $61.77 / $77.20
| Professional | | $54.05 | $61.77 | $77.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.29 / $14.05 / $17.55
| Professional | 26 | $12.29 | $14.05 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.76 / $47.72 / $59.65
| Professional | TC | $41.76 | $47.72 | $59.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.20 / $16.20 / $16.20
| Facility | 26 | $16.20 | $16.20 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.25 / $67.56 / $108.65
| Professional | | $43.25 | $67.56 | $108.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.22 / $18.14 / $29.75
| Professional | 26 | $12.22 | $18.14 | $29.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.04 / $48.29 / $78.69
| Professional | TC | $31.04 | $48.29 | $78.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.46 / $70.00 / $70.00
| Facility | 26 | $33.46 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.26 / $45.57 / $325.58
| Professional | | $39.26 | $45.57 | $325.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.69 / $12.13 / $91.83
| Professional | 26 | $10.69 | $12.13 | $91.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.44 / $32.85 / $233.75
| Professional | TC | $28.44 | $32.85 | $233.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.26 / $43.72 / $99.26
| Professional | | $39.26 | $43.72 | $99.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.69 / $11.90 / $28.23
| Professional | 26 | $10.69 | $11.90 | $28.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.44 / $31.82 / $71.45
| Professional | TC | $28.44 | $31.82 | $71.45 |