- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.39 / $29.50 / $38.18
| Facility | 26 | $14.39 | $29.50 | $38.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.23 / $42.36 / $74.34
| Professional | | $26.23 | $42.36 | $74.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.75 / $15.38 / $26.89
| Professional | 26 | $13.75 | $15.38 | $26.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.47 / $27.78 / $51.90
| Professional | TC | $12.47 | $27.78 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.03 / $47.81 / $85.98
| Professional | | $32.03 | $47.81 | $85.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.73 / $19.73 / $30.22
| Professional | 26 | $14.73 | $19.73 | $30.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.08 / $29.98 / $55.32
| Professional | TC | $15.08 | $29.98 | $55.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.55 / $16.55 / $16.55
| Facility | 26 | $16.55 | $16.55 | $16.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.76 / $44.77 / $83.78
| Professional | | $31.76 | $44.77 | $83.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $20.66 / $35.09
| Professional | 26 | $14.79 | $20.66 | $35.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.50 / $25.18 / $55.44
| Professional | TC | $13.50 | $25.18 | $55.44 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.90 / $71.11 / $80.00
| Facility | 26 | $33.90 | $71.11 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.10 / $306.10 / $371.25
| Professional | | $306.10 | $306.10 | $371.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.99 / $93.99 / $115.50
| Professional | 26 | $93.99 | $93.99 | $115.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $212.11 / $212.11 / $255.75
| Professional | TC | $212.11 | $212.11 | $255.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.68 / $39.78 / $77.37
| Professional | | $25.68 | $39.78 | $77.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $17.55 / $31.67
| Professional | 26 | $13.50 | $17.55 | $31.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.88 / $22.73 / $46.17
| Professional | TC | $11.88 | $22.73 | $46.17 |