- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.10 / $13.74 / $19.71
| Facility | 26 | $10.10 | $13.74 | $19.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.97 / $43.91 / $47.95
| Professional | | $29.97 | $43.91 | $47.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.35 / $11.74 / $13.07
| Professional | 26 | $8.35 | $11.74 | $13.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.62 / $31.88 / $35.36
| Professional | TC | $21.62 | $31.88 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.21 / $9.24 / $19.64
| Professional | 26 | $9.21 | $9.24 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.89 / $42.89 / $42.89
| Professional | TC | $42.89 | $42.89 | $42.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $43.40 / $59.59
| Professional | | $12.60 | $43.40 | $59.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.74 / $11.74 / $18.88
| Facility | 26 | $11.74 | $11.74 | $18.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.09 / $40.19 / $63.46
| Professional | | $34.09 | $40.19 | $63.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.65 / $12.55 / $19.17
| Professional | 26 | $10.65 | $12.55 | $19.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.35 / $27.64 / $43.57
| Professional | TC | $22.35 | $27.64 | $43.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.34 / $100.00 / $100.00
| Facility | 26 | $29.34 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.39 / $51.61 / $306.22
| Professional | | $38.39 | $51.61 | $306.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.66 / $13.76 / $95.76
| Professional | 26 | $11.66 | $13.76 | $95.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.41 / $32.61 / $250.00
| Professional | TC | $25.41 | $32.61 | $250.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.25 / $44.23 / $70.00
| Professional | | $36.25 | $44.23 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $12.89 / $20.57
| Professional | 26 | $10.97 | $12.89 | $20.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.64 / $31.08 / $49.20
| Professional | TC | $24.64 | $31.08 | $49.20 |