- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.79 / $8.39 / $12.65
| Facility | 26 | $6.79 | $8.39 | $12.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.10 / $33.35 / $38.53
| Professional | | $24.10 | $33.35 | $38.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.67 / $7.78 / $8.55
| Professional | 26 | $5.67 | $7.78 | $8.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.43 / $25.57 / $29.99
| Professional | TC | $18.43 | $25.57 | $29.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $36.40 / $36.40
| Professional | | $36.40 | $36.40 | $36.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.22 / $6.22 / $10.50
| Professional | 26 | $6.22 | $6.22 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $35.00 / $48.06
| Professional | | $8.77 | $35.00 | $48.06 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.79 / $7.79 / $12.79
| Facility | 26 | $7.79 | $7.79 | $12.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $31.64 / $48.10
| Professional | | $25.77 | $31.64 | $48.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.25 / $12.56
| Professional | 26 | $6.98 | $8.25 | $12.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.98 / $23.38 / $36.79
| Professional | TC | $17.98 | $23.38 | $36.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.60 / $100.00 / $100.00
| Facility | 26 | $19.60 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.57 / $37.49 / $245.68
| Professional | | $29.57 | $37.49 | $245.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.67 / $9.18 / $61.09
| Professional | 26 | $7.67 | $9.18 | $61.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.09 / $26.40 / $192.57
| Professional | TC | $21.09 | $26.40 | $192.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.54 / $34.02 / $57.09
| Professional | | $28.54 | $34.02 | $57.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.67 / $8.57 / $14.44
| Professional | 26 | $7.67 | $8.57 | $14.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.84 / $26.40 / $44.72
| Professional | TC | $20.84 | $26.40 | $44.72 |