- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $13.67 / $14.83
| Facility | 26 | $13.49 | $13.67 | $14.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.22 / $35.59 / $47.97
| Professional | | $34.22 | $35.59 | $47.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.92 / $13.69 / $18.97
| Professional | 26 | $12.92 | $13.69 | $18.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.75 / $22.67 / $29.00
| Professional | TC | $20.75 | $22.67 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.04 / $36.31 / $46.93
| Professional | | $33.04 | $36.31 | $46.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.67 / $14.33 / $17.52
| Professional | 26 | $13.67 | $14.33 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.35 / $36.04 / $49.50
| Professional | | $14.35 | $36.04 | $49.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.60 / $48.92 / $61.64
| Professional | | $37.60 | $48.92 | $61.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.34 / $19.29 / $24.81
| Professional | 26 | $14.34 | $19.29 | $24.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.83 / $28.37 / $36.76
| Professional | TC | $22.83 | $28.37 | $36.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.53 / $100.00 / $100.00
| Facility | 26 | $33.53 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.95 / $43.93 / $348.00
| Professional | | $32.95 | $43.93 | $348.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.42 / $16.20 / $89.60
| Professional | 26 | $12.42 | $16.20 | $89.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.63 / $25.80 / $198.00
| Professional | TC | $19.63 | $25.80 | $198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.76 / $40.32 / $63.07
| Professional | | $31.76 | $40.32 | $63.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.17 / $15.48 / $24.21
| Professional | 26 | $12.17 | $15.48 | $24.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.63 / $25.20 / $37.94
| Professional | TC | $19.63 | $25.20 | $37.94 |