- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.98 / $48.98
| Facility | 26 | $10.96 | $16.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $75.86 / $323.59
| Facility | TC | $28.84 | $75.86 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $43.65 / $151.36
| Professional | | $32.36 | $43.65 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $15.85 / $39.81
| Professional | 26 | $10.00 | $15.85 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $28.18 / $64.57
| Professional | TC | $20.89 | $28.18 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $14.45 / $14.45
| Facility | 26 | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Facility | TC | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $47.86 / $95.50
| Professional | | $28.84 | $47.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $15.85 / $30.90
| Professional | 26 | $8.32 | $15.85 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $31.62 / $64.57
| Professional | TC | $20.89 | $31.62 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.09 / $16.60 / $40.74
| Facility | 26 | $3.09 | $16.60 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $6.92 / $37.15 / $100.00
| Facility | TC | $6.92 | $37.15 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $53.70 / $107.15
| Professional | | $33.11 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $18.20 / $34.67
| Professional | 26 | $10.47 | $18.20 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $36.31 / $77.62
| Professional | TC | $22.39 | $36.31 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $83.18
| Professional | | $32.36 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $14.79 / $26.92
| Professional | 26 | $10.96 | $14.79 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.18 / $56.23
| Professional | TC | $21.88 | $28.18 | $56.23 |