- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.77 / $13.50
| Facility | 26 | $7.08 | $9.77 | $13.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.33 / $36.09 / $38.86
| Professional | | $24.33 | $36.09 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.90 / $8.34 / $8.88
| Professional | 26 | $5.90 | $8.34 | $8.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.43 / $27.11 / $29.99
| Professional | TC | $18.43 | $27.11 | $29.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.48 / $6.48 / $6.48
| Professional | 26 | $6.48 | $6.48 | $6.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $35.35 / $48.54
| Professional | | $8.75 | $35.35 | $48.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $8.13 / $13.36
| Facility | 26 | $8.13 | $8.13 | $13.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.95 / $31.98 / $49.41
| Professional | | $24.95 | $31.98 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.53 / $8.60 / $13.56
| Professional | 26 | $7.53 | $8.60 | $13.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.82 / $23.38 / $37.64
| Professional | TC | $16.82 | $23.38 | $37.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.47 / $100.00 / $100.00
| Facility | 26 | $20.47 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.81 / $37.17 / $293.00
| Professional | | $29.81 | $37.17 | $293.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.99 / $9.55 / $55.28
| Professional | 26 | $7.99 | $9.55 | $55.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.85 / $26.40 / $283.00
| Professional | TC | $20.85 | $26.40 | $283.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $33.72 / $56.18
| Professional | | $28.59 | $33.72 | $56.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $8.91 / $14.22
| Professional | 26 | $7.97 | $8.91 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.14 / $25.91 / $44.72
| Professional | TC | $20.14 | $25.91 | $44.72 |