- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.18 / $13.49
| Facility | 26 | $7.94 | $13.18 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $57.54 / $114.82
| Professional | | $50.12 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $9.33 / $21.88
| Professional | 26 | $7.59 | $9.33 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.69 / $47.86 / $85.11
| Professional | TC | $41.69 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $81.28
| Professional | | $50.12 | $60.26 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $9.55 / $12.30
| Professional | 26 | $7.59 | $9.55 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | TC | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $53.70 / $74.13
| Professional | | $8.71 | $53.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $69.18 / $91.20
| Professional | | $54.95 | $69.18 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $11.48 / $15.14
| Professional | 26 | $9.12 | $11.48 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.71 / $58.88 / $75.86
| Professional | TC | $45.71 | $58.88 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $20.42 / $79.43
| Facility | 26 | $20.42 | $20.42 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $63.10 / $371.54
| Professional | | $46.77 | $63.10 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $10.23 / $54.95
| Professional | 26 | $7.76 | $10.23 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $52.48 / $316.23
| Professional | TC | $38.02 | $52.48 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $93.33
| Professional | | $44.67 | $57.54 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $9.55 / $14.79
| Professional | 26 | $7.59 | $9.55 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.31 / $47.86 / $77.62
| Professional | TC | $36.31 | $47.86 | $77.62 |