- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.05 / $14.64 / $23.80
| Facility | 26 | $12.05 | $14.64 | $23.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.04 / $36.79 / $50.82
| Professional | | $35.04 | $36.79 | $50.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.03 / $10.60 / $15.66
| Professional | 26 | $10.03 | $10.60 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.44 / $26.45 / $35.45
| Professional | TC | $24.44 | $26.45 | $35.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $7.71 / $7.79
| Professional | 26 | $7.71 | $7.71 | $7.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.42 / $26.42 / $26.42
| Professional | TC | $26.42 | $26.42 | $26.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.06 / $67.06 / $67.06
| Professional | | $67.06 | $67.06 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.14 / $50.51 / $66.91
| Professional | | $27.14 | $50.51 | $66.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $15.82 / $21.91
| Professional | 26 | $10.02 | $15.82 | $21.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.86 / $37.82 / $52.88
| Professional | TC | $20.86 | $37.82 | $52.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.59 / $24.59 / $100.00
| Facility | 26 | $24.59 | $24.59 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.07 / $49.11 / $262.00
| Professional | | $37.07 | $49.11 | $262.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.55 / $15.02 / $107.32
| Professional | 26 | $11.55 | $15.02 | $107.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.32 / $33.67 / $249.00
| Professional | TC | $25.32 | $33.67 | $249.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.35 / $40.86 / $63.19
| Professional | | $36.35 | $40.86 | $63.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.52 / $12.71 / $20.93
| Professional | 26 | $11.52 | $12.71 | $20.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.58 / $28.34 / $43.55
| Professional | TC | $24.58 | $28.34 | $43.55 |