- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $11.54 / $18.91
| Facility | 26 | $7.44 | $11.54 | $18.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.96 / $31.21 / $41.02
| Professional | | $18.96 | $31.21 | $41.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.48 / $12.24 / $15.39
| Professional | 26 | $7.48 | $12.24 | $15.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.48 / $19.30 / $25.80
| Professional | TC | $11.48 | $19.30 | $25.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.91 / $18.91 / $23.70
| Professional | 26 | $18.91 | $18.91 | $23.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.05 / $39.14 / $53.83
| Professional | | $15.05 | $39.14 | $53.83 |
- 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
- $14.96 / $26.74 / $55.48
| Professional | | $14.96 | $26.74 | $55.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.44 / $11.54 / $20.35
| Professional | 26 | $7.44 | $11.54 | $20.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.27 / $15.84 / $35.13
| Professional | TC | $8.27 | $15.84 | $35.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.32 / $100.00 / $100.00
| Facility | 26 | $35.32 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.30 / $41.49 / $738.38
| Professional | | $18.30 | $41.49 | $738.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $15.43 / $95.54
| Professional | 26 | $7.59 | $15.43 | $95.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.61 / $26.06 / $724.28
| Professional | TC | $9.61 | $26.06 | $724.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.16 / $39.29 / $64.05
| Professional | | $16.16 | $39.29 | $64.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.58 / $14.13 / $22.34
| Professional | 26 | $7.58 | $14.13 | $22.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.09 / $24.24 / $40.21
| Professional | TC | $9.09 | $24.24 | $40.21 |