- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.32 / $11.67 / $15.15
| Facility | 26 | $9.32 | $11.67 | $15.15 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $23.27 / $32.72 / $103.30
| Facility | TC | $23.27 | $32.72 | $103.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.48 / $33.89 / $56.11
| Professional | | $24.48 | $33.89 | $56.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.58 / $10.61 / $16.67
| Professional | 26 | $7.58 | $10.61 | $16.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.02 / $23.27 / $42.04
| Professional | TC | $18.02 | $23.27 | $42.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.62 / $9.91 / $20.57
| Professional | 26 | $6.62 | $9.91 | $20.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.61 / $42.15 / $51.39
| Professional | | $37.61 | $42.15 | $51.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.64 / $13.60 / $16.94
| Professional | 26 | $10.64 | $13.60 | $16.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.29 / $30.83 / $36.11
| Professional | TC | $26.29 | $30.83 | $36.11 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $20.84 / $20.84 / $23.56
| Facility | TC | $20.84 | $20.84 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.18 / $8.22 / $8.89
| Professional | 26 | $6.18 | $8.22 | $8.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.45 / $31.35 / $55.00
| Professional | | $19.45 | $31.35 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.60 / $9.86 / $16.93
| Professional | 26 | $5.60 | $9.86 | $16.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.86 / $22.15 / $39.36
| Professional | TC | $13.86 | $22.15 | $39.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.43 / $32.22 / $51.39
| Professional | | $23.43 | $32.22 | $51.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.54 / $10.00 / $16.37
| Professional | 26 | $7.54 | $10.00 | $16.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.99 / $22.38 / $35.81
| Professional | TC | $14.99 | $22.38 | $35.81 |