- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.12 / $28.95 / $37.46
| Facility | 26 | $14.12 | $28.95 | $37.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.17 / $52.77 / $82.95
| Professional | | $45.17 | $52.77 | $82.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.62 / $15.57 / $27.66
| Professional | 26 | $13.62 | $15.57 | $27.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.89 / $36.54 / $57.01
| Professional | TC | $30.89 | $36.54 | $57.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.09 / $66.25 / $101.46
| Professional | | $47.09 | $66.25 | $101.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.48 / $20.84 / $32.42
| Professional | 26 | $14.48 | $20.84 | $32.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.64 / $45.92 / $71.28
| Professional | TC | $32.64 | $45.92 | $71.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.25 / $16.25 / $16.25
| Facility | 26 | $16.25 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.25 / $69.59 / $114.45
| Professional | | $48.25 | $69.59 | $114.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.70 / $21.25 / $35.15
| Professional | 26 | $14.70 | $21.25 | $35.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.19 / $48.41 / $80.61
| Professional | TC | $33.19 | $48.41 | $80.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.90 / $70.00 / $80.00
| Facility | 26 | $32.90 | $70.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.00 / $541.00 / $541.00
| Professional | | $541.00 | $541.00 | $541.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $91.83 / $91.83 / $109.58
| Professional | 26 | $91.83 | $91.83 | $109.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $217.68 / $223.65 / $235.95
| Professional | TC | $217.68 | $223.65 | $235.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.42 / $60.59 / $106.34
| Professional | | $47.42 | $60.59 | $106.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $18.63 / $33.60
| Professional | 26 | $13.50 | $18.63 | $33.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.59 / $41.51 / $73.16
| Professional | TC | $31.59 | $41.51 | $73.16 |