- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.25 / $7.44 / $11.54
| Facility | 26 | $6.25 | $7.44 | $11.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.34 / $26.63 / $30.93
| Professional | | $18.34 | $26.63 | $30.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.23 / $7.41 / $8.22
| Professional | 26 | $5.23 | $7.41 | $8.22 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $9.17 / $13.32 / $14.57
| Professional | 52 | $9.17 | $13.32 | $14.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.10 / $19.14 / $22.70
| Professional | TC | $13.10 | $19.14 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.20 / $28.20 / $41.78
| Professional | | $28.20 | $28.20 | $41.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.73 / $5.73 / $12.64
| Professional | 26 | $5.73 | $5.73 | $12.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.87 / $26.60 / $36.53
| Professional | | $7.87 | $26.60 | $36.53 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.15 / $7.15 / $11.74
| Facility | 26 | $7.15 | $7.15 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.64 / $24.94 / $39.99
| Professional | | $21.64 | $24.94 | $39.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.69 / $7.61 / $12.04
| Professional | 26 | $6.69 | $7.61 | $12.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.49 / $17.13 / $28.30
| Professional | TC | $14.49 | $17.13 | $28.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.09 / $100.00 / $100.00
| Facility | 26 | $18.09 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.23 / $31.36 / $184.96
| Professional | | $24.23 | $31.36 | $184.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.07 / $8.46 / $67.13
| Professional | 26 | $7.07 | $8.46 | $67.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.17 / $19.97 / $149.00
| Professional | TC | $16.17 | $19.97 | $149.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.12 / $27.08 / $42.77
| Professional | | $23.12 | $27.08 | $42.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.06 / $7.89 / $13.37
| Professional | 26 | $7.06 | $7.89 | $13.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.55 / $18.95 / $30.32
| Professional | TC | $15.55 | $18.95 | $30.32 |