- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.24 / $29.61 / $37.01
| Facility | 26 | $12.24 | $29.61 | $37.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.81 / $33.57 / $65.38
| Professional | | $25.81 | $33.57 | $65.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.90 / $8.46 / $18.71
| Professional | 26 | $6.90 | $8.46 | $18.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.72 / $25.66 / $51.90
| Professional | TC | $19.72 | $25.66 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.04 / $39.22 / $51.31
| Professional | | $25.04 | $39.22 | $51.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $11.85 / $11.85
| Professional | 26 | $6.61 | $11.85 | $11.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.62 / $33.85 / $42.31
| Professional | | $29.62 | $33.85 | $42.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.04 / $6.90 / $8.63
| Professional | 26 | $6.04 | $6.90 | $8.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.58 / $26.94 / $33.68
| Professional | TC | $23.58 | $26.94 | $33.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $40.77 / $67.93
| Professional | | $29.48 | $40.77 | $67.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.37 / $10.72 / $18.64
| Professional | 26 | $7.37 | $10.72 | $18.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.63 / $29.49 / $49.84
| Professional | TC | $20.63 | $29.49 | $49.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $37.17 / $293.00
| Professional | | $29.74 | $37.17 | $293.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.50 / $9.38 / $55.28
| Professional | 26 | $8.50 | $9.38 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.92 / $27.79 / $283.00
| Professional | TC | $20.92 | $27.79 | $283.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.05 / $37.17 / $58.97
| Professional | | $29.05 | $37.17 | $58.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.41 / $9.38 / $16.55
| Professional | 26 | $8.41 | $9.38 | $16.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.84 / $27.79 / $43.07
| Professional | TC | $20.84 | $27.79 | $43.07 |