- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.67 / $26.02 / $52.04
| Professional | | $19.67 | $26.02 | $52.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.68 / $20.00 / $23.72
| Professional | 26 | $16.68 | $20.00 | $23.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.02 / $4.50 / $28.32
| Professional | TC | $3.02 | $4.50 | $28.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $20.14 / $24.05
| Professional | | $20.14 | $20.14 | $24.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.68 / $16.68 / $19.92
| Professional | 26 | $16.68 | $16.68 | $19.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.46 / $3.46 / $4.13
| Professional | TC | $3.46 | $3.46 | $4.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.93 / $30.74 / $66.09
| Professional | | $19.93 | $30.74 | $66.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.67 / $19.87 / $31.63
| Professional | 26 | $16.67 | $19.87 | $31.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.29 / $4.98 / $40.96
| Professional | TC | $3.29 | $4.98 | $40.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.22 / $100.00 / $100.00
| Facility | 26 | $48.22 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.75 / $42.78 / $313.77
| Professional | | $21.75 | $42.78 | $313.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.36 / $20.80 / $156.85
| Professional | 26 | $17.36 | $20.80 | $156.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.60 / $15.30 / $220.13
| Professional | TC | $3.60 | $15.30 | $220.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.35 / $31.90 / $57.72
| Professional | | $21.35 | $31.90 | $57.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.11 / $19.23 / $33.22
| Professional | 26 | $17.11 | $19.23 | $33.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.10 / $4.99 / $36.47
| Professional | TC | $3.10 | $4.99 | $36.47 |