- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.57 / $10.06 / $57.35
| Facility | 26 | $9.57 | $10.06 | $57.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.26 / $41.46 / $45.07
| Professional | | $28.26 | $41.46 | $45.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.91 / $9.98 / $11.91
| Professional | 26 | $7.91 | $9.98 | $11.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.34 / $30.06 / $33.01
| Professional | TC | $20.34 | $30.06 | $33.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.50 / $44.50 / $44.50
| Professional | | $44.50 | $44.50 | $44.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.90 / $40.95 / $56.23
| Professional | | $11.90 | $40.95 | $56.23 |
- 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
- $33.78 / $39.47 / $64.18
| Professional | | $33.78 | $39.47 | $64.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.96 / $10.77 / $16.59
| Professional | 26 | $8.96 | $10.77 | $16.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.82 / $28.25 / $47.19
| Professional | TC | $23.82 | $28.25 | $47.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.85 / $103.00 / $103.00
| Facility | 26 | $27.85 | $103.00 | $103.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.11 / $50.23 / $286.68
| Professional | | $37.11 | $50.23 | $286.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.24 / $12.43 / $107.32
| Professional | 26 | $10.24 | $12.43 | $107.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.83 / $36.00 / $267.00
| Professional | TC | $24.83 | $36.00 | $267.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.97 / $42.68 / $67.11
| Professional | | $33.97 | $42.68 | $67.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.21 / $12.00 / $18.95
| Professional | 26 | $10.21 | $12.00 | $18.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.76 / $33.54 / $49.66
| Professional | TC | $23.76 | $33.54 | $49.66 |