- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.66 / $10.11 / $12.18
| Facility | 26 | $7.66 | $10.11 | $12.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.73 / $27.91 / $45.15
| Professional | | $23.73 | $27.91 | $45.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.36 / $7.82 / $12.06
| Professional | 26 | $7.36 | $7.82 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.05 / $19.51 / $31.87
| Professional | TC | $16.05 | $19.51 | $31.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.97 / $25.39 / $30.23
| Professional | | $22.97 | $25.39 | $30.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.49 / $8.99 / $10.78
| Professional | 26 | $7.49 | $8.99 | $10.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $27.30 / $37.49
| Professional | | $8.05 | $27.30 | $37.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.82 / $40.92 / $52.83
| Professional | | $27.82 | $40.92 | $52.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.17 / $10.97 / $13.94
| Professional | 26 | $8.17 | $10.97 | $13.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.36 / $29.27 / $39.51
| Professional | TC | $19.36 | $29.27 | $39.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.87 / $100.00 / $100.00
| Facility | 26 | $18.87 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.80 / $37.34 / $400.00
| Professional | | $27.80 | $37.34 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.43 / $132.09
| Professional | 26 | $7.08 | $9.43 | $132.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.94 / $28.80 / $135.32
| Professional | TC | $21.94 | $28.80 | $135.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.80 / $37.17 / $54.30
| Professional | | $27.80 | $37.17 | $54.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.95 / $8.92 / $13.76
| Professional | 26 | $6.95 | $8.92 | $13.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.12 / $28.04 / $44.71
| Professional | TC | $21.12 | $28.04 | $44.71 |