- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $17.38 / $18.62
| Facility | 26 | $8.91 | $17.38 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $33.11 / $56.23
| Professional | | $23.99 | $33.11 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $7.94 / $19.95
| Professional | 26 | $6.03 | $7.94 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $23.99 / $37.15
| Professional | TC | $16.98 | $23.99 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.17 / $6.31 / $8.91
| Professional | 26 | $6.17 | $6.31 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $23.99 / $28.18
| Professional | TC | $19.50 | $23.99 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $52.48 / $52.48
| Professional | | $52.48 | $52.48 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $39.81 / $63.10
| Professional | | $23.44 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.96 / $18.20
| Professional | 26 | $7.08 | $10.96 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $29.51 / $51.29
| Professional | TC | $18.20 | $29.51 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $19.50 / $100.00
| Facility | 26 | $19.50 | $19.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.02 / $208.93
| Professional | | $29.51 | $38.02 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.72 / $66.07
| Professional | 26 | $7.94 | $10.72 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $27.54 / $186.21
| Professional | TC | $21.38 | $27.54 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $31.62 / $50.12
| Professional | | $29.51 | $31.62 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $9.12 / $14.45
| Professional | 26 | $7.94 | $9.12 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $22.91 / $35.48
| Professional | TC | $21.38 | $22.91 | $35.48 |