- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.61 / $10.58 / $18.86
| Facility | 26 | $9.61 | $10.58 | $18.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.46 / $44.01 / $72.02
| Professional | | $34.46 | $44.01 | $72.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.22 / $10.35 / $16.67
| Professional | 26 | $9.22 | $10.35 | $16.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.85 / $29.46 / $53.79
| Professional | TC | $24.85 | $29.46 | $53.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.64 / $38.04 / $72.23
| Professional | | $26.64 | $38.04 | $72.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.56 / $11.28 / $13.51
| Professional | 26 | $9.56 | $11.28 | $13.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.15 / $42.35 / $58.15
| Professional | | $10.15 | $42.35 | $58.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.96 / $66.91 / $89.09
| Professional | | $39.96 | $66.91 | $89.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.54 / $17.00 / $22.80
| Professional | 26 | $10.54 | $17.00 | $22.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.09 / $50.01 / $67.33
| Professional | TC | $29.09 | $50.01 | $67.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.82 / $100.00 / $100.00
| Facility | 26 | $23.82 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.31 / $61.79 / $632.00
| Professional | | $44.31 | $61.79 | $632.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.93 / $14.74 / $223.21
| Professional | 26 | $10.93 | $14.74 | $223.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.54 / $49.26 / $259.02
| Professional | TC | $37.54 | $49.26 | $259.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.26 / $62.08 / $88.74
| Professional | | $47.26 | $62.08 | $88.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.68 / $14.02 / $22.03
| Professional | 26 | $10.68 | $14.02 | $22.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.20 / $46.92 / $68.40
| Professional | TC | $36.20 | $46.92 | $68.40 |