- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.83 / $12.83 / $12.83
| Facility | 26 | $12.83 | $12.83 | $12.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.40 / $45.87 / $84.99
| Professional | | $35.40 | $45.87 | $84.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.75 / $12.83 / $29.16
| Professional | 26 | $9.75 | $12.83 | $29.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.01 / $33.04 / $59.20
| Professional | TC | $26.01 | $33.04 | $59.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.42 / $50.68 / $89.76
| Professional | | $39.42 | $50.68 | $89.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.72 / $15.08 / $26.23
| Professional | 26 | $11.72 | $15.08 | $26.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.39 / $35.58 / $63.42
| Professional | TC | $27.39 | $35.58 | $63.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $28.95 / $39.23
| Professional | | $22.10 | $28.95 | $39.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.96 / $72.45 / $85.09
| Professional | | $62.96 | $72.45 | $85.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.85 / $20.83 / $24.13
| Professional | 26 | $17.85 | $20.83 | $24.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.11 / $50.12 / $61.04
| Professional | TC | $45.11 | $50.12 | $61.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.40 / $42.47 / $69.55
| Professional | | $38.40 | $42.47 | $69.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.78 / $12.99 / $21.43
| Professional | 26 | $10.78 | $12.99 | $21.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.27 / $30.92 / $53.94
| Professional | TC | $27.27 | $30.92 | $53.94 |