- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.05 / $35.40 / $59.09
| Facility | 26 | $22.05 | $35.40 | $59.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.23 / $41.27 / $89.01
| Professional | | $26.23 | $41.27 | $89.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $15.38 / $50.00
| Professional | 26 | $13.49 | $15.38 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.47 / $20.26 / $60.21
| Professional | TC | $12.47 | $20.26 | $60.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.40 / $44.55 / $48.45
| Professional | | $33.40 | $44.55 | $48.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.82 / $14.43 / $15.69
| Professional | 26 | $10.82 | $14.43 | $15.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.59 / $30.12 / $32.76
| Professional | TC | $22.59 | $30.12 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.63 / $45.89 / $86.80
| Professional | | $29.63 | $45.89 | $86.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.17 / $18.68 / $34.14
| Professional | 26 | $14.17 | $18.68 | $34.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.86 / $27.56 / $54.96
| Professional | TC | $13.86 | $27.56 | $54.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.90 / $33.90 / $80.00
| Facility | 26 | $33.90 | $33.90 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.32 / $38.82 / $306.10
| Professional | | $24.32 | $38.82 | $306.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.02 / $16.67 / $93.99
| Professional | 26 | $13.02 | $16.67 | $93.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.85 / $23.10 / $212.11
| Professional | TC | $10.85 | $23.10 | $212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.87 / $38.49 / $75.65
| Professional | | $23.87 | $38.49 | $75.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.90 / $15.48 / $29.12
| Professional | 26 | $12.90 | $15.48 | $29.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.54 / $21.46 / $46.32
| Professional | TC | $10.54 | $21.46 | $46.32 |