- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.63 / $20.44 / $72.70
| Facility | 26 | $11.63 | $20.44 | $72.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $41.21 / $72.67
| Professional | | $38.86 | $41.21 | $72.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.36 / $12.30 / $20.86
| Professional | 26 | $11.36 | $12.30 | $20.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.54 / $29.52 / $51.56
| Professional | TC | $26.54 | $29.52 | $51.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.64 / $72.64 / $72.64
| Professional | | $72.64 | $72.64 | $72.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $9.94 / $10.30
| Professional | 26 | $9.86 | $9.94 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.79 / $60.60 / $102.12
| Professional | | $33.79 | $60.60 | $102.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.97 / $21.14 / $34.09
| Professional | 26 | $12.97 | $21.14 | $34.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.87 / $40.24 / $71.56
| Professional | TC | $24.87 | $40.24 | $71.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.41 / $15.41 / $16.62
| Facility | 26 | $15.41 | $15.41 | $16.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.72 / $56.45 / $98.06
| Professional | | $37.72 | $56.45 | $98.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.77 / $19.23 / $31.08
| Professional | 26 | $11.77 | $19.23 | $31.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.27 / $38.58 / $68.93
| Professional | TC | $26.27 | $38.58 | $68.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.36 / $100.00 / $100.00
| Facility | 26 | $34.36 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.05 / $438.00 / $438.00
| Professional | | $400.05 | $438.00 | $438.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $97.41 / $97.41 / $107.48
| Professional | 26 | $97.41 | $97.41 | $107.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $292.58 / $423.00 / $423.00
| Professional | TC | $292.58 | $423.00 | $423.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.13 / $51.80 / $89.83
| Professional | | $42.13 | $51.80 | $89.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.43 / $16.27 / $28.88
| Professional | 26 | $13.43 | $16.27 | $28.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.57 / $35.18 / $61.73
| Professional | TC | $28.57 | $35.18 | $61.73 |