- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.46 / $15.55 / $19.34
| Facility | 26 | $12.46 | $15.55 | $19.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.49 / $66.48 / $243.00
| Professional | | $38.49 | $66.48 | $243.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $15.45 / $51.00
| Professional | 26 | $9.86 | $15.45 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $50.57 / $61.46
| Professional | TC | $26.30 | $50.57 | $61.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.59 / $41.39 / $57.57
| Professional | | $30.59 | $41.39 | $57.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.22 / $11.05 / $14.15
| Professional | 26 | $9.22 | $11.05 | $14.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.54 / $50.77 / $98.29
| Professional | | $40.54 | $50.77 | $98.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $13.32 / $23.30
| Professional | 26 | $11.16 | $13.32 | $23.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.38 / $37.04 / $75.64
| Professional | TC | $29.38 | $37.04 | $75.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.22 / $13.07 / $13.07
| Professional | 26 | $10.22 | $13.07 | $13.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.60 / $11.60 / $11.60
| Facility | 26 | $11.60 | $11.60 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.39 / $54.56 / $102.06
| Professional | | $39.39 | $54.56 | $102.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.57 / $14.14 / $25.25
| Professional | 26 | $10.57 | $14.14 | $25.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.55 / $40.96 / $78.40
| Professional | TC | $28.55 | $40.96 | $78.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.38 / $58.46 / $96.74
| Professional | | $46.38 | $58.46 | $96.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.68 / $13.35 / $22.84
| Professional | 26 | $10.68 | $13.35 | $22.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.19 / $44.75 / $71.83
| Professional | TC | $35.19 | $44.75 | $71.83 |