- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $11.48 / $16.60
| Facility | 26 | $10.23 | $11.48 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $66.07 / $144.54
| Professional | | $51.29 | $66.07 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.00 / $22.91
| Professional | 26 | $7.94 | $10.00 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $8.13 / $8.13 / $8.32
| Professional | 52 | $8.13 | $8.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $52.48 / $93.33
| Professional | TC | $42.66 | $52.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $60.26 / $100.00
| Professional | | $46.77 | $60.26 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $9.55 / $14.45
| Professional | 26 | $7.94 | $9.55 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $63.10 / $74.13
| Professional | | $51.29 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $10.47 / $12.88
| Professional | 26 | $9.12 | $10.47 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.69 / $52.48 / $61.66
| Professional | TC | $41.69 | $52.48 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $9.12 / $9.33
| Professional | 26 | $9.12 | $9.12 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.14 / $10.00 / $14.13
| Facility | 26 | $2.14 | $10.00 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $117.49
| Professional | | $51.29 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $11.48 / $20.42
| Professional | 26 | $8.51 | $11.48 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $56.23 / $97.72
| Professional | TC | $42.66 | $56.23 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $56.23 / $91.20
| Professional | | $44.67 | $56.23 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $9.12 / $14.45
| Professional | 26 | $7.24 | $9.12 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.31 / $46.77 / $74.13
| Professional | TC | $36.31 | $46.77 | $74.13 |