- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.82 / $21.43 / $31.25
| Facility | 26 | $10.82 | $21.43 | $31.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.16 / $23.94 / $45.15
| Professional | | $17.16 | $23.94 | $45.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.86 / $7.49 / $17.16
| Professional | 26 | $5.86 | $7.49 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.32 / $16.76 / $30.83
| Professional | TC | $11.32 | $16.76 | $30.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $21.22 / $21.22
| Professional | | $16.80 | $21.22 | $21.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.85 / $8.17 / $17.55
| Professional | 26 | $5.85 | $8.17 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.42 / $21.06 / $26.32
| Professional | | $18.42 | $21.06 | $26.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.34 / $6.10 / $7.63
| Professional | 26 | $5.34 | $6.10 | $7.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.08 / $14.95 / $18.69
| Professional | TC | $13.08 | $14.95 | $18.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $8.86 / $8.86
| Facility | 26 | $8.86 | $8.86 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $28.56 / $46.88
| Professional | | $19.95 | $28.56 | $46.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.45 / $8.96 / $15.88
| Professional | 26 | $6.45 | $8.96 | $15.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.68 / $18.76 / $32.79
| Professional | TC | $13.68 | $18.76 | $32.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | 26 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.20 / $24.54 / $542.00
| Professional | | $22.20 | $24.54 | $542.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $8.30 / $62.74
| Professional | 26 | $7.20 | $8.30 | $62.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.95 / $16.68 / $498.00
| Professional | TC | $14.95 | $16.68 | $498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.20 / $24.54 / $42.01
| Professional | | $22.20 | $24.54 | $42.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $8.30 / $13.69
| Professional | 26 | $7.20 | $8.30 | $13.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.35 / $16.30 / $25.99
| Professional | TC | $14.35 | $16.30 | $25.99 |