- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $18.20 / $18.20
| Facility | 26 | $12.30 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $38.90 / $40.74
| Facility | TC | $26.92 | $38.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $46.77 / $100.00
| Professional | | $33.88 | $46.77 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $18.20 / $47.86
| Professional | 26 | $10.96 | $18.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $32.36 / $67.61
| Professional | TC | $20.89 | $32.36 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $28.18 / $53.70
| Professional | | $26.92 | $28.18 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $16.98 / $18.62
| Professional | 26 | $13.80 | $16.98 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Professional | TC | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $67.61 / $87.10
| Professional | | $46.77 | $67.61 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $26.30 / $33.88
| Professional | 26 | $18.62 | $26.30 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $40.74 / $52.48
| Professional | TC | $28.84 | $40.74 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $18.62 / $18.62
| Facility | 26 | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Facility | TC | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $53.70 / $104.71
| Professional | | $33.11 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $20.89 / $39.81
| Professional | 26 | $13.80 | $20.89 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $36.31 / $79.43
| Professional | TC | $25.12 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $42.66 / $70.79
| Professional | | $33.88 | $42.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $14.45 / $24.55
| Professional | 26 | $11.48 | $14.45 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $28.18 / $42.66
| Professional | TC | $22.39 | $28.18 | $42.66 |