- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.30 / $32.36
| Facility | 26 | $7.94 | $12.30 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $63.10 / $269.15
| Facility | TC | $22.91 | $63.10 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $36.31 / $112.20
| Professional | | $19.05 | $36.31 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $11.75 / $33.88
| Professional | 26 | $7.08 | $11.75 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $22.91 / $51.29
| Professional | TC | $16.98 | $22.91 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Facility | 26 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Facility | TC | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $36.31 / $74.13
| Professional | | $26.92 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $11.48 / $21.38
| Professional | 26 | $8.13 | $11.48 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $25.12 / $52.48
| Professional | TC | $17.78 | $25.12 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.19 / $11.75 / $28.18
| Facility | 26 | $2.19 | $11.75 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $5.62 / $30.20 / $79.43
| Facility | TC | $5.62 | $30.20 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $40.74 / $83.18
| Professional | | $25.12 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $12.88 / $24.55
| Professional | 26 | $7.41 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $28.84 / $61.66
| Professional | TC | $17.78 | $28.84 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.11 / $63.10
| Professional | | $25.12 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $10.23 / $19.05
| Professional | 26 | $7.76 | $10.23 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $22.39 / $44.67
| Professional | TC | $16.98 | $22.39 | $44.67 |