- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.59 / $17.38
| Facility | 26 | $7.94 | $12.59 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $25.12 / $42.66
| Professional | | $18.20 | $25.12 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $8.91 / $19.05
| Professional | 26 | $6.03 | $8.91 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.02 / $16.98 / $26.30
| Professional | TC | $12.02 | $16.98 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $18.62 / $45.71
| Professional | | $17.38 | $18.62 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.75 / $5.89 / $8.91
| Professional | 26 | $5.75 | $5.89 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $16.60 / $16.60
| Professional | TC | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $30.20 / $47.86
| Professional | | $17.38 | $30.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.46 / $10.00 / $16.22
| Professional | 26 | $6.46 | $10.00 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.59 / $20.89 / $33.88
| Professional | TC | $12.59 | $20.89 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $18.20 / $100.00
| Facility | 26 | $18.20 | $18.20 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $28.84 / $537.03
| Professional | | $23.44 | $28.84 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $9.77 / $63.10
| Professional | 26 | $7.24 | $9.77 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.49 / $19.50 / $501.19
| Professional | TC | $15.49 | $19.50 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $24.55 / $38.90
| Professional | | $22.91 | $24.55 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $8.32 / $13.18
| Professional | 26 | $7.24 | $8.32 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.49 / $16.22 / $25.70
| Professional | TC | $15.49 | $16.22 | $25.70 |