- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $10.69 / $19.91
| Facility | 26 | $9.94 | $10.69 | $19.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.87 / $36.58 / $44.21
| Professional | | $29.87 | $36.58 | $44.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.92 / $8.68 / $13.48
| Professional | 26 | $7.92 | $8.68 | $13.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.94 / $28.16 / $33.85
| Professional | TC | $21.94 | $28.16 | $33.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.44 / $27.44 / $32.95
| Professional | | $27.44 | $27.44 | $32.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.44 / $6.44 / $6.44
| Professional | 26 | $6.44 | $6.44 | $6.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.11 / $54.11 / $54.11
| Professional | | $54.11 | $54.11 | $54.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.78 / $44.88 / $69.12
| Professional | | $25.78 | $44.88 | $69.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.25 / $12.57 / $16.27
| Professional | 26 | $7.25 | $12.57 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.14 / $33.42 / $58.04
| Professional | TC | $19.14 | $33.42 | $58.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.47 / $20.47 / $100.00
| Facility | 26 | $20.47 | $20.47 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.61 / $40.89 / $293.00
| Professional | | $29.61 | $40.89 | $293.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.69 / $11.27 / $55.28
| Professional | 26 | $8.69 | $11.27 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.92 / $30.57 / $283.00
| Professional | TC | $20.92 | $30.57 | $283.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.61 / $37.17 / $59.47
| Professional | | $29.61 | $37.17 | $59.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.69 / $9.56 / $15.95
| Professional | 26 | $8.69 | $9.56 | $15.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.92 / $27.46 / $46.89
| Professional | TC | $20.92 | $27.46 | $46.89 |