- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.58 / $34.64 / $57.83
| Facility | 26 | $21.58 | $34.64 | $57.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.49 / $52.77 / $278.58
| Professional | | $38.49 | $52.77 | $278.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $15.09 / $79.93
| Professional | 26 | $12.88 | $15.09 | $79.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.61 / $36.54 / $198.65
| Professional | TC | $25.61 | $36.54 | $198.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.15 / $41.54 / $45.17
| Professional | | $31.15 | $41.54 | $45.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.32 / $13.76 / $14.96
| Professional | 26 | $10.32 | $13.76 | $14.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.83 / $27.78 / $30.21
| Professional | TC | $20.83 | $27.78 | $30.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.59 / $67.93 / $115.53
| Professional | | $45.59 | $67.93 | $115.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.32 / $19.50 / $34.17
| Professional | 26 | $14.32 | $19.50 | $34.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.66 / $48.07 / $81.83
| Professional | TC | $31.66 | $48.07 | $81.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.90 / $32.90 / $80.00
| Facility | 26 | $32.90 | $32.90 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.26 / $61.42 / $541.00
| Professional | | $45.26 | $61.42 | $541.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.20 / $17.39 / $91.83
| Professional | 26 | $13.20 | $17.39 | $91.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.93 / $42.87 / $217.68
| Professional | TC | $31.93 | $42.87 | $217.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.94 / $55.87 / $99.60
| Professional | | $43.94 | $55.87 | $99.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.20 / $16.45 / $30.87
| Professional | 26 | $13.20 | $16.45 | $30.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.80 / $39.14 / $71.40
| Professional | TC | $31.80 | $39.14 | $71.40 |