- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.33 / $8.33 / $8.33
| Facility | 26 | $8.33 | $8.33 | $8.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.94 / $49.88 / $74.77
| Professional | | $45.94 | $49.88 | $74.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.70 / $8.33 / $12.57
| Professional | 26 | $7.70 | $8.33 | $12.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.03 / $41.55 / $62.21
| Professional | TC | $38.03 | $41.55 | $62.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.39 / $81.73 / $114.53
| Professional | | $50.39 | $81.73 | $114.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.99 / $12.96 / $18.16
| Professional | 26 | $7.99 | $12.96 | $18.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.40 / $68.76 / $96.37
| Professional | TC | $42.40 | $68.76 | $96.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.34 / $100.94 / $132.57
| Professional | | $43.34 | $100.94 | $132.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.32 / $16.67 / $21.81
| Professional | 26 | $7.32 | $16.67 | $21.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.42 / $84.95 / $109.04
| Professional | TC | $36.42 | $84.95 | $109.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.41 / $68.56 / $145.86
| Professional | | $48.41 | $68.56 | $145.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.44 / $12.40 / $26.39
| Professional | 26 | $8.44 | $12.40 | $26.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.65 / $56.17 / $119.47
| Professional | TC | $40.65 | $56.17 | $119.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.00 / $105.15 / $133.62
| Professional | | $67.00 | $105.15 | $133.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.39 / $68.56 / $120.15
| Professional | | $48.39 | $68.56 | $120.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $12.40 / $21.74
| Professional | 26 | $7.97 | $12.40 | $21.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.08 / $56.17 / $103.29
| Professional | TC | $38.08 | $56.17 | $103.29 |