- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $10.17 / $56.76
| Facility | 26 | $7.33 | $10.17 | $56.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $27.52 / $38.54
| Professional | | $18.14 | $27.52 | $38.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.11 / $8.65 / $10.15
| Professional | 26 | $6.11 | $8.65 | $10.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $9.08 / $13.50 / $14.40
| Professional | 52 | $9.08 | $13.50 | $14.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.04 / $18.87 / $28.39
| Professional | TC | $12.04 | $18.87 | $28.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.10 / $26.25 / $36.04
| Professional | | $9.10 | $26.25 | $36.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.40 / $9.40 / $14.98
| Facility | 26 | $9.40 | $9.40 | $14.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.54 / $31.42 / $55.16
| Professional | | $24.54 | $31.42 | $55.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $9.97 / $16.23
| Professional | 26 | $7.97 | $9.97 | $16.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.57 / $21.07 / $38.90
| Professional | TC | $16.57 | $21.07 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.10 / $100.00 / $100.00
| Facility | 26 | $21.10 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.72 / $36.38 / $216.00
| Professional | | $27.72 | $36.38 | $216.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.47 / $10.57 / $79.26
| Professional | 26 | $8.47 | $10.57 | $79.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.16 / $26.53 / $205.00
| Professional | TC | $19.16 | $26.53 | $205.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $34.94 / $48.96
| Professional | | $27.00 | $34.94 | $48.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.47 / $9.85 / $15.64
| Professional | 26 | $8.47 | $9.85 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.82 / $24.22 / $35.00
| Professional | TC | $18.82 | $24.22 | $35.00 |