- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.26 / $7.10 / $40.50
| Facility | 26 | $6.26 | $7.10 | $40.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.78 / $22.69 / $24.77
| Professional | | $15.78 | $22.69 | $24.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.23 / $7.17 / $7.87
| Professional | 26 | $5.23 | $7.17 | $7.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.55 / $15.20 / $16.89
| Professional | TC | $10.55 | $15.20 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.54 / $33.54 / $33.54
| Professional | | $33.54 | $33.54 | $33.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.73 / $5.73 / $9.68
| Professional | 26 | $5.73 | $5.73 | $9.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $22.75 / $31.24
| Professional | | $7.74 | $22.75 | $31.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.10 / $7.10 / $11.17
| Facility | 26 | $7.10 | $7.10 | $11.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.03 / $21.34 / $34.52
| Professional | | $19.03 | $21.34 | $34.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.40 / $7.54 / $11.52
| Professional | 26 | $6.40 | $7.54 | $11.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.16 / $13.81 / $23.00
| Professional | TC | $12.16 | $13.81 | $23.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.09 / $100.00 / $100.00
| Facility | 26 | $18.09 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.26 / $27.68 / $542.00
| Professional | | $20.26 | $27.68 | $542.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.06 / $8.30 / $62.74
| Professional | 26 | $7.06 | $8.30 | $62.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.99 / $16.67 / $498.00
| Professional | TC | $12.99 | $16.67 | $498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $23.87 / $40.69
| Professional | | $19.63 | $23.87 | $40.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.87 / $7.89 / $12.60
| Professional | 26 | $6.87 | $7.89 | $12.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.08 / $15.75 / $24.36
| Professional | TC | $12.08 | $15.75 | $24.36 |