- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.50 / $7.73 / $12.56
| Facility | 26 | $6.50 | $7.73 | $12.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.47 / $28.82 / $32.49
| Professional | | $20.47 | $28.82 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.45 / $7.72 / $10.07
| Professional | 26 | $5.45 | $7.72 | $10.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.02 / $21.35 / $24.29
| Professional | TC | $15.02 | $21.35 | $24.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.89 / $42.89 / $42.89
| Professional | | $42.89 | $42.89 | $42.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.92 / $6.34 / $12.61
| Professional | 26 | $5.92 | $6.34 | $12.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $29.75 / $40.85
| Professional | | $8.40 | $29.75 | $40.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $7.44 / $11.74
| Facility | 26 | $7.44 | $7.44 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.73 / $27.34 / $41.97
| Professional | | $22.73 | $27.34 | $41.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.69 / $7.91 / $12.04
| Professional | 26 | $6.69 | $7.91 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.07 / $19.43 / $30.94
| Professional | TC | $15.07 | $19.43 | $30.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.72 / $100.00 / $100.00
| Facility | 26 | $18.72 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.46 / $34.94 / $206.66
| Professional | | $25.46 | $34.94 | $206.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.36 / $8.67 / $79.26
| Professional | 26 | $7.36 | $8.67 | $79.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.52 / $22.41 / $161.00
| Professional | TC | $17.52 | $22.41 | $161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.66 / $30.17 / $48.15
| Professional | | $24.66 | $30.17 | $48.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.36 / $8.23 / $14.80
| Professional | 26 | $7.36 | $8.23 | $14.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.28 / $21.94 / $34.65
| Professional | TC | $17.28 | $21.94 | $34.65 |