- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $6.92 / $9.12
| Facility | 26 | $3.02 | $6.92 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $16.98 / $36.31
| Professional | | $12.88 | $16.98 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.00 / $3.72 / $8.51
| Professional | 26 | $2.00 | $3.72 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $14.13 / $25.70
| Professional | TC | $10.96 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $13.80 / $16.22
| Professional | | $11.75 | $13.80 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $2.69 / $3.16
| Professional | 26 | $2.29 | $2.69 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $26.92 / $44.67
| Professional | | $16.98 | $26.92 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.47 / $6.92 / $10.72
| Professional | 26 | $4.47 | $6.92 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $23.99 / $37.15
| Professional | TC | $16.22 | $23.99 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $0.65 / $3.02 / $4.37
| Facility | 26 | $0.65 | $3.02 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $26.30 / $41.69
| Professional | | $15.85 | $26.30 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $6.17 / $9.33
| Professional | 26 | $3.02 | $6.17 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.59 / $20.42 / $33.88
| Professional | TC | $12.59 | $20.42 | $33.88 |
- 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
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $33.11 / $36.31
| Professional | 26 | $33.11 | $33.11 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | TC | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $24.55 / $38.90
| Professional | | $17.38 | $24.55 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.72 / $5.62 / $8.51
| Professional | 26 | $3.72 | $5.62 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.13 / $19.05 / $30.90
| Professional | TC | $14.13 | $19.05 | $30.90 |