- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.55 / $8.07 / $46.06
| Facility | 26 | $6.55 | $8.07 | $46.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.91 / $29.82 / $33.15
| Professional | | $20.91 | $29.82 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.46 / $7.71 / $8.19
| Professional | 26 | $5.46 | $7.71 | $8.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.45 / $22.05 / $24.96
| Professional | TC | $15.45 | $22.05 | $24.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.73 / $23.73 / $32.58
| Professional | | $23.73 | $23.73 | $32.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.22 / $6.22 / $10.50
| Professional | 26 | $6.22 | $6.22 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $30.10 / $41.33
| Professional | | $8.05 | $30.10 | $41.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.79 / $7.79 / $12.79
| Facility | 26 | $7.79 | $7.79 | $12.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $27.99 / $43.15
| Professional | | $23.44 | $27.99 | $43.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $8.25 / $12.56
| Professional | 26 | $6.98 | $8.25 | $12.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.65 / $19.73 / $31.78
| Professional | TC | $15.65 | $19.73 | $31.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.60 / $100.00 / $100.00
| Facility | 26 | $19.60 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.85 / $35.72 / $210.99
| Professional | | $26.85 | $35.72 | $210.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.67 / $9.18 / $82.56
| Professional | 26 | $7.67 | $9.18 | $82.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.94 / $22.76 / $159.97
| Professional | TC | $17.94 | $22.76 | $159.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $30.86 / $49.15
| Professional | | $25.61 | $30.86 | $49.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.67 / $8.57 / $13.65
| Professional | 26 | $7.67 | $8.57 | $13.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.59 / $22.29 / $37.24
| Professional | TC | $17.59 | $22.29 | $37.24 |