- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.03 / $13.41 / $24.24
| Facility | 26 | $11.03 | $13.41 | $24.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $33.96 / $51.87
| Professional | | $17.14 | $33.96 | $51.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.32 / $13.13 / $22.96
| Professional | 26 | $7.32 | $13.13 | $22.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.11 / $21.00 / $31.54
| Professional | TC | $10.11 | $21.00 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.09 / $14.94 / $34.58
| Professional | 26 | $11.09 | $14.94 | $34.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.01 / $28.50 / $82.74
| Professional | | $15.01 | $28.50 | $82.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $13.30 / $30.55
| Professional | 26 | $7.90 | $13.30 | $30.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.16 / $15.56 / $49.49
| Professional | TC | $8.16 | $15.56 | $49.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.48 / $9.48 / $17.32
| Facility | 26 | $9.48 | $9.48 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.55 / $33.06 / $78.20
| Professional | | $17.55 | $33.06 | $78.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.28 / $13.42 / $30.57
| Professional | 26 | $8.28 | $13.42 | $30.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.55 / $20.85 / $48.28
| Professional | TC | $9.55 | $20.85 | $48.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.38 / $753.15 / $753.15
| Professional | | $738.38 | $753.15 | $753.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $95.54 / $95.54 / $122.10
| Professional | 26 | $95.54 | $95.54 | $122.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $724.28 / $738.76 / $738.76
| Professional | TC | $724.28 | $738.76 | $738.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.26 / $40.14 / $78.61
| Professional | | $19.26 | $40.14 | $78.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.24 / $15.44 / $30.42
| Professional | 26 | $8.24 | $15.44 | $30.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.46 / $25.24 / $49.41
| Professional | TC | $10.46 | $25.24 | $49.41 |