- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.66 / $8.66 / $55.18
| Facility | 26 | $8.66 | $8.66 | $55.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.04 / $17.63 / $28.12
| Professional | | $15.04 | $17.63 | $28.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.66 / $9.19 / $17.85
| Professional | 26 | $8.66 | $9.19 | $17.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.38 / $7.52 / $12.62
| Professional | TC | $6.38 | $7.52 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.40 / $24.40 / $24.40
| Professional | | $24.40 | $24.40 | $24.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.40 / $16.64 / $23.00
| Professional | 26 | $7.40 | $16.64 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $27.30 / $45.52
| Professional | | $13.66 | $27.30 | $45.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.65 / $15.29 / $25.33
| Professional | 26 | $9.65 | $15.29 | $25.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.45 / $13.18 / $20.36
| Professional | TC | $7.45 | $13.18 | $20.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $11.16 / $12.61
| Facility | 26 | $11.16 | $11.16 | $12.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $28.29 / $51.48
| Professional | | $16.64 | $28.29 | $51.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.93 / $14.34 / $23.51
| Professional | 26 | $8.93 | $14.34 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.26 / $12.75 / $25.84
| Professional | TC | $7.26 | $12.75 | $25.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.45 / $100.00 / $100.00
| Facility | 26 | $29.45 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.44 / $206.87 / $206.87
| Professional | | $186.44 | $206.87 | $206.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $105.66 / $105.66 / $105.66
| Professional | 26 | $105.66 | $105.66 | $105.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $129.58 / $133.46 / $133.46
| Professional | TC | $129.58 | $133.46 | $133.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $23.64 / $40.21
| Professional | | $18.07 | $23.64 | $40.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.08 / $12.39 / $21.66
| Professional | 26 | $10.08 | $12.39 | $21.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.97 / $10.99 / $20.25
| Professional | TC | $7.97 | $10.99 | $20.25 |