- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.80 / $12.17 / $31.31
| Facility | 26 | $11.80 | $12.17 | $31.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.54 / $41.15 / $66.90
| Professional | | $36.54 | $41.15 | $66.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.06 / $12.59 / $17.77
| Professional | 26 | $11.06 | $12.59 | $17.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.95 / $29.32 / $40.29
| Professional | TC | $24.95 | $29.32 | $40.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.85 / $53.49 / $84.37
| Professional | | $37.85 | $53.49 | $84.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.10 / $17.14 / $26.22
| Professional | 26 | $12.10 | $17.14 | $26.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.43 / $36.68 / $57.87
| Professional | TC | $25.43 | $36.68 | $57.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.91 / $13.91 / $13.91
| Facility | 26 | $13.91 | $13.91 | $13.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $52.43 / $83.78
| Professional | | $38.00 | $52.43 | $83.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.38 / $16.26 / $25.23
| Professional | 26 | $12.38 | $16.26 | $25.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.52 / $36.56 / $57.86
| Professional | TC | $25.52 | $36.56 | $57.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.55 / $80.00 / $85.00
| Facility | 26 | $28.55 | $80.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.93 / $251.93 / $372.23
| Professional | | $251.93 | $251.93 | $372.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $76.73 / $76.73 / $96.68
| Professional | 26 | $76.73 | $76.73 | $96.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $175.19 / $175.19 / $275.55
| Professional | TC | $175.19 | $175.19 | $275.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.28 / $45.65 / $78.88
| Professional | | $35.28 | $45.65 | $78.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.79 / $14.30 / $25.58
| Professional | 26 | $10.79 | $14.30 | $25.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.23 / $30.66 / $53.12
| Professional | TC | $24.23 | $30.66 | $53.12 |