- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.24 / $16.55 / $17.86
| Facility | 26 | $11.24 | $16.55 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.71 / $41.00 / $53.36
| Professional | | $38.71 | $41.00 | $53.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.76 / $11.24 / $16.32
| Professional | 26 | $10.76 | $11.24 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.48 / $29.92 / $37.03
| Professional | TC | $27.48 | $29.92 | $37.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.77 / $39.77 / $41.72
| Professional | | $39.77 | $39.77 | $41.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.15 / $10.98 / $13.18
| Professional | 26 | $10.15 | $10.98 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.90 / $40.60 / $55.75
| Professional | | $11.90 | $40.60 | $55.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.91 / $54.52 / $69.44
| Professional | | $42.91 | $54.52 | $69.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.04 / $16.07 / $20.43
| Professional | 26 | $12.04 | $16.07 | $20.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.18 / $37.97 / $48.92
| Professional | TC | $31.18 | $37.97 | $48.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.92 / $80.00 / $80.00
| Facility | 26 | $27.92 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.84 / $47.91 / $89.35
| Professional | | $36.84 | $47.91 | $89.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.46 / $13.87 / $74.58
| Professional | 26 | $10.46 | $13.87 | $74.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.41 / $33.35 / $203.39
| Professional | TC | $25.41 | $33.35 | $203.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.51 / $45.72 / $71.92
| Professional | | $35.51 | $45.72 | $71.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.10 / $13.26 / $20.52
| Professional | 26 | $10.10 | $13.26 | $20.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.41 / $33.35 / $51.55
| Professional | TC | $25.41 | $33.35 | $51.55 |