- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $8.09 / $12.18
| Facility | 26 | $7.08 | $8.09 | $12.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.07 / $29.12 / $31.82
| Professional | | $20.07 | $29.12 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.90 / $8.34 / $10.82
| Professional | 26 | $5.90 | $8.34 | $10.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.17 / $20.66 / $22.94
| Professional | TC | $14.17 | $20.66 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.44 / $8.31 / $13.19
| Professional | 26 | $6.44 | $8.31 | $13.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.44 / $25.44 / $25.44
| Professional | TC | $25.44 | $25.44 | $25.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $29.05 / $39.89
| Professional | | $8.75 | $29.05 | $39.89 |
- 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
- $21.98 / $26.75 / $41.55
| Professional | | $21.98 | $26.75 | $41.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.48 / $12.75
| Professional | 26 | $6.98 | $8.48 | $12.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.19 / $18.22 / $28.43
| Professional | TC | $14.19 | $18.22 | $28.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.44 / $100.00 / $100.00
| Facility | 26 | $63.44 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.07 / $31.78 / $202.27
| Professional | | $25.07 | $31.78 | $202.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $9.46 / $111.75
| Professional | 26 | $7.90 | $9.46 | $111.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.55 / $20.88 / $146.99
| Professional | TC | $16.55 | $20.88 | $146.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.06 / $29.10 / $47.12
| Professional | | $24.06 | $29.10 | $47.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.50 / $8.73 / $14.07
| Professional | 26 | $7.50 | $8.73 | $14.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.55 / $19.48 / $34.56
| Professional | TC | $16.55 | $19.48 | $34.56 |