- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $12.59 / $32.36
| Facility | 26 | $7.08 | $12.59 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $50.12 / $144.54
| Facility | TC | $21.38 | $50.12 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $28.84 / $81.28
| Professional | | $19.05 | $28.84 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $9.33 / $30.90
| Professional | 26 | $6.03 | $9.33 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $20.89 / $43.65
| Professional | TC | $15.14 | $20.89 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Facility | TC | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.88 / $67.61
| Professional | | $25.12 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $10.47 / $19.05
| Professional | 26 | $7.24 | $10.47 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $23.44 / $48.98
| Professional | TC | $17.38 | $23.44 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1.95 / $10.47 / $25.12
| Facility | 26 | $1.95 | $10.47 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $5.01 / $26.92 / $70.79
| Facility | TC | $5.01 | $26.92 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $38.02 / $75.86
| Professional | | $22.91 | $38.02 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $11.22 / $21.88
| Professional | 26 | $6.61 | $11.22 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $26.92 / $57.54
| Professional | TC | $16.22 | $26.92 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $30.20 / $57.54
| Professional | | $22.91 | $30.20 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $9.12 / $16.98
| Professional | 26 | $6.92 | $9.12 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $21.38 / $40.74
| Professional | TC | $16.22 | $21.38 | $40.74 |