- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.40 / $27.59 / $31.82
| Facility | 26 | $10.40 | $27.59 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.64 / $35.25 / $63.14
| Professional | | $28.64 | $35.25 | $63.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.11 / $13.66 / $33.00
| Professional | 26 | $10.11 | $13.66 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.64 / $21.58 / $34.51
| Professional | TC | $18.64 | $21.58 | $34.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $19.48 / $25.56
| Professional | 26 | $7.41 | $19.48 | $25.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.40 / $44.79 / $70.20
| Professional | | $29.40 | $44.79 | $70.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.54 / $17.80 / $26.28
| Professional | 26 | $11.54 | $17.80 | $26.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.30 / $27.36 / $44.64
| Professional | TC | $19.30 | $27.36 | $44.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.90 / $11.90 / $18.64
| Facility | 26 | $11.90 | $11.90 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.33 / $42.51 / $74.98
| Professional | | $29.33 | $42.51 | $74.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.14 / $17.21 / $28.70
| Professional | 26 | $11.14 | $17.21 | $28.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.44 / $26.78 / $45.35
| Professional | TC | $18.44 | $26.78 | $45.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.00 / $70.00 / $70.00
| Facility | 26 | $50.00 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.66 / $195.66 / $254.63
| Professional | | $195.66 | $195.66 | $254.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $69.84 / $69.84 / $83.70
| Professional | 26 | $69.84 | $69.84 | $83.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $129.61 / $129.61 / $170.93
| Professional | TC | $129.61 | $129.61 | $170.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.10 / $43.08 / $76.67
| Professional | | $34.10 | $43.08 | $76.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.43 / $17.41 / $29.08
| Professional | 26 | $13.43 | $17.41 | $29.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.86 / $27.27 / $50.52
| Professional | TC | $20.86 | $27.27 | $50.52 |