- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.73 / $10.77 / $17.20
| Facility | 26 | $8.73 | $10.77 | $17.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $23.35 / $50.53 / $232.94
| Facility | TC | $23.35 | $50.53 | $232.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.61 / $31.41 / $65.15
| Professional | | $24.61 | $31.41 | $65.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.89 / $9.40 / $24.40
| Professional | 26 | $7.89 | $9.40 | $24.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.32 / $21.68 / $43.32
| Professional | TC | $18.32 | $21.68 | $43.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $10.02 / $10.02
| Facility | 26 | $10.02 | $10.02 | $10.02 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $21.15 / $21.15 / $21.15
| Facility | TC | $21.15 | $21.15 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.21 / $36.95 / $61.20
| Professional | | $28.21 | $36.95 | $61.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.73 / $11.68 / $18.13
| Professional | 26 | $8.73 | $11.68 | $18.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.49 / $27.19 / $43.36
| Professional | TC | $20.49 | $27.19 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $10.36 / $10.36
| Facility | 26 | $10.36 | $10.36 | $10.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $27.15 / $27.15 / $27.15
| Facility | TC | $27.15 | $27.15 | $27.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.23 / $39.72 / $70.72
| Professional | | $28.23 | $39.72 | $70.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.21 / $12.88 / $21.04
| Professional | 26 | $8.21 | $12.88 | $21.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.23 / $28.02 / $48.91
| Professional | TC | $19.23 | $28.02 | $48.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $35.27 / $60.96
| Professional | | $28.01 | $35.27 | $60.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.96 / $11.09 / $19.46
| Professional | 26 | $8.96 | $11.09 | $19.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.02 / $24.57 / $42.40
| Professional | TC | $19.02 | $24.57 | $42.40 |