- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $12.88 / $22.39
| Facility | 26 | $12.02 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $95.50
| Professional | | $32.36 | $40.74 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $15.85 / $44.67
| Professional | 26 | $10.00 | $15.85 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.18 / $81.28
| Professional | TC | $21.88 | $28.18 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $109.65
| Professional | | $75.86 | $100.00 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $28.84 / $31.62
| Professional | 26 | $21.38 | $28.84 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.70 / $70.79 / $79.43
| Professional | TC | $53.70 | $70.79 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $66.07 / $102.33
| Professional | | $33.88 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $18.20 / $32.36
| Professional | 26 | $11.75 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $46.77 / $70.79
| Professional | TC | $23.99 | $46.77 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $72.44 / $275.42
| Professional | | $39.81 | $72.44 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $24.55 / $79.43
| Professional | 26 | $12.88 | $24.55 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $47.86 / $194.98
| Professional | TC | $26.92 | $47.86 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $66.07 / $102.33
| Professional | | $38.90 | $66.07 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $21.38 / $33.88
| Professional | 26 | $12.88 | $21.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $42.66 / $72.44
| Professional | TC | $25.70 | $42.66 | $72.44 |