- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $8.44 / $45.10
| Facility | 26 | $7.20 | $8.44 | $45.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $28.20 / $54.44
| Professional | | $25.77 | $28.20 | $54.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $7.91 / $14.04
| Professional | 26 | $7.20 | $7.91 | $14.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.55 / $20.39 / $39.14
| Professional | TC | $18.55 | $20.39 | $39.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.22 / $45.62 / $45.62
| Professional | | $29.22 | $45.62 | $45.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.16 / $7.68 / $19.20
| Professional | 26 | $6.16 | $7.68 | $19.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.58 / $42.18 / $68.13
| Professional | | $23.58 | $42.18 | $68.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.00 / $12.95 / $20.78
| Professional | 26 | $8.00 | $12.95 | $20.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.14 / $29.80 / $50.71
| Professional | TC | $18.14 | $29.80 | $50.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.61 / $9.61 / $10.31
| Facility | 26 | $9.61 | $9.61 | $10.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.14 / $38.72 / $67.41
| Professional | | $26.14 | $38.72 | $67.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.30 / $11.92 / $19.27
| Professional | 26 | $7.30 | $11.92 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.51 / $27.90 / $50.96
| Professional | TC | $18.51 | $27.90 | $50.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.54 / $100.00 / $100.00
| Facility | 26 | $24.54 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.83 / $208.83 / $272.63
| Professional | | $208.83 | $208.83 | $272.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $66.04 / $66.04 / $67.73
| Professional | 26 | $66.04 | $66.04 | $67.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $188.00 / $188.00 / $204.83
| Professional | TC | $188.00 | $188.00 | $204.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.52 / $34.22 / $59.38
| Professional | | $28.52 | $34.22 | $59.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.30 / $10.30 / $18.04
| Professional | 26 | $8.30 | $10.30 | $18.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.94 / $23.92 / $41.98
| Professional | TC | $19.94 | $23.92 | $41.98 |