- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.25 / $24.71 / $35.42
| Professional | | $14.25 | $24.71 | $35.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.61 / $5.00 / $6.87
| Professional | 26 | $2.61 | $5.00 | $6.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.33 / $19.69 / $28.35
| Professional | TC | $11.33 | $19.69 | $28.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $13.64 / $15.74
| Professional | | $11.25 | $13.64 | $15.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.99 / $2.41 / $2.74
| Professional | 26 | $1.99 | $2.41 | $2.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.27 / $11.23 / $12.78
| Professional | TC | $9.27 | $11.23 | $12.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.64 / $25.22 / $49.41
| Professional | | $14.64 | $25.22 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.69 / $5.66 / $10.25
| Professional | 26 | $2.69 | $5.66 | $10.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.95 / $19.61 / $39.15
| Professional | TC | $11.95 | $19.61 | $39.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.94 / $100.00 / $100.00
| Facility | 26 | $5.94 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.53 / $25.48 / $161.00
| Professional | | $19.53 | $25.48 | $161.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.25 / $5.76 / $54.00
| Professional | 26 | $4.25 | $5.76 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.50 / $19.78 / $129.00
| Professional | TC | $15.50 | $19.78 | $129.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.20 / $23.94 / $39.13
| Professional | | $19.20 | $23.94 | $39.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.03 / $5.32 / $8.61
| Professional | 26 | $4.03 | $5.32 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.44 / $18.55 / $31.01
| Professional | TC | $14.44 | $18.55 | $31.01 |