- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.17 / $10.26 / $18.42
| Facility | 26 | $9.17 | $10.26 | $18.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $32.21 / $37.75
| Professional | | $26.78 | $32.21 | $37.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.02 / $12.50
| Professional | 26 | $7.33 | $8.02 | $12.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $24.19 / $31.79
| Professional | TC | $19.46 | $24.19 | $31.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.90 / $23.90 / $23.90
| Professional | | $23.90 | $23.90 | $23.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.18 / $6.18 / $6.21
| Professional | 26 | $6.18 | $6.18 | $6.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.72 / $17.72 / $17.72
| Professional | TC | $17.72 | $17.72 | $17.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.94 / $44.94 / $44.94
| Professional | | $44.94 | $44.94 | $44.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $38.95 / $59.14
| Professional | | $22.10 | $38.95 | $59.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $11.78 / $15.64
| Professional | 26 | $6.98 | $11.78 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.03 / $30.00 / $48.37
| Professional | TC | $17.03 | $30.00 | $48.37 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.60 / $19.60 / $100.00
| Facility | 26 | $19.60 | $19.60 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.50 / $36.60 / $210.99
| Professional | | $28.50 | $36.60 | $210.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.31 / $10.81 / $82.56
| Professional | 26 | $8.31 | $10.81 | $82.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.19 / $25.91 / $159.97
| Professional | TC | $20.19 | $25.91 | $159.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.50 / $32.36 / $51.97
| Professional | | $28.50 | $32.36 | $51.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.31 / $9.28 / $15.34
| Professional | 26 | $8.31 | $9.28 | $15.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.19 / $23.18 / $38.70
| Professional | TC | $20.19 | $23.18 | $38.70 |