- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.46 / $10.36 / $60.62
| Facility | 26 | $8.46 | $10.36 | $60.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $38.34 / $41.90
| Professional | | $26.30 | $38.34 | $41.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.02 / $9.88 / $10.56
| Professional | 26 | $7.02 | $9.88 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.28 / $28.24 / $31.34
| Professional | TC | $19.28 | $28.24 | $31.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.16 / $10.16 / $10.16
| Professional | 26 | $10.16 | $10.16 | $10.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $38.15 / $52.39
| Professional | | $10.50 | $38.15 | $52.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.08 / $10.08 / $16.12
| Facility | 26 | $10.08 | $10.08 | $16.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.03 / $34.86 / $55.06
| Professional | | $30.03 | $34.86 | $55.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.96 / $10.57 / $16.12
| Professional | 26 | $8.96 | $10.57 | $16.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.02 / $24.30 / $38.47
| Professional | TC | $20.02 | $24.30 | $38.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.59 / $100.00 / $100.00
| Facility | 26 | $24.59 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.49 / $45.21 / $267.27
| Professional | | $33.49 | $45.21 | $267.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.85 / $11.64 / $85.85
| Professional | 26 | $9.85 | $11.64 | $85.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.36 / $28.87 / $244.00
| Professional | TC | $22.36 | $28.87 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $38.40 / $60.63
| Professional | | $32.21 | $38.40 | $60.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.24 / $10.82 / $17.59
| Professional | 26 | $9.24 | $10.82 | $17.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.74 / $27.43 / $43.30
| Professional | TC | $20.74 | $27.43 | $43.30 |