- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $29.51 / $29.51
| Facility | 26 | $14.13 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $45.71 / $81.28
| Professional | | $26.92 | $45.71 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.85 / $36.31
| Professional | 26 | $12.02 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.02 / $30.20 / $52.48
| Professional | TC | $12.02 | $30.20 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $46.77 / $85.11
| Professional | | $10.47 | $46.77 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $22.91 / $34.67
| Professional | 26 | $15.85 | $22.91 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $33.11 / $63.10
| Professional | TC | $18.20 | $33.11 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.55 / $16.60 / $23.44
| Facility | 26 | $3.55 | $16.60 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $42.66 / $89.13
| Professional | | $31.62 | $42.66 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $20.89 / $36.31
| Professional | 26 | $14.79 | $20.89 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.49 / $24.55 / $60.26
| Professional | TC | $13.49 | $24.55 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | 26 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $371.54
| Professional | | $309.03 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $93.33 / $114.82 / $114.82
| Professional | 26 | $93.33 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $213.80 / $257.04 / $257.04
| Professional | TC | $213.80 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $38.90 / $67.61
| Professional | | $26.92 | $38.90 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $17.78 / $30.20
| Professional | 26 | $13.49 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $22.39 / $42.66
| Professional | TC | $11.75 | $22.39 | $42.66 |