- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $37.15 / $46.77
| Facility | 26 | $11.48 | $37.15 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $20.89 / $77.62
| Professional | | $14.13 | $20.89 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.96 / $37.15
| Professional | 26 | $7.94 | $10.96 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.03 / $8.91 / $22.39
| Professional | TC | $6.03 | $8.91 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $17.78 / $27.54
| Professional | | $15.14 | $17.78 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $13.49 / $17.38
| Professional | 26 | $7.41 | $13.49 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $17.38 / $31.62
| Professional | | $14.13 | $17.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $8.91 / $15.85
| Professional | 26 | $6.92 | $8.91 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.08 / $8.71 / $16.22
| Professional | TC | $7.08 | $8.71 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.45 / $11.48 / $16.22
| Facility | 26 | $2.45 | $11.48 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $26.30 / $42.66
| Professional | | $15.85 | $26.30 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $12.02 / $21.88
| Professional | 26 | $8.32 | $12.02 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.92 / $12.59 / $23.99
| Professional | TC | $6.92 | $12.59 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $100.00 / $100.00
| Facility | 26 | $23.44 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.99 / $208.93
| Professional | | $19.50 | $23.99 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $11.48 / $104.71
| Professional | 26 | $9.77 | $11.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.71 / $12.59 / $128.82
| Professional | TC | $8.71 | $12.59 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $21.88 / $33.88
| Professional | | $19.50 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $10.72 / $15.85
| Professional | 26 | $9.33 | $10.72 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.71 / $10.96 / $17.78
| Professional | TC | $8.71 | $10.96 | $17.78 |