- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.71 / $45.71 / $45.71
| Facility | 26 | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $15.85 / $38.90
| Professional | | $10.72 | $15.85 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.00 / $46.77
| Professional | 26 | $7.08 | $10.00 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.02 / $3.98 / $10.23
| Professional | TC | $3.02 | $3.98 | $10.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $56.23 / $69.18
| Facility | | $39.81 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $14.13 / $29.51
| Professional | | $10.47 | $14.13 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $9.55 / $19.50
| Professional | 26 | $6.61 | $9.55 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.16 / $4.47 / $6.03
| Professional | TC | $3.16 | $4.47 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $81.28 / $144.54
| Facility | | $18.20 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $16.22 / $30.90
| Professional | | $11.75 | $16.22 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $12.30 / $19.05
| Professional | 26 | $7.41 | $12.30 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.55 / $6.03 / $10.96
| Professional | TC | $3.55 | $6.03 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $13.80 / $22.91
| Professional | | $10.47 | $13.80 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $10.00 / $15.49
| Professional | 26 | $7.76 | $10.00 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $2.19 / $4.47 / $8.13
| Professional | TC | $2.19 | $4.47 | $8.13 |