- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.00 / $10.02 / $14.65
| Facility | 26 | $9.00 | $10.02 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $33.76 / $58.00
| Professional | | $23.61 | $33.76 | $58.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.84 / $9.47 / $14.65
| Professional | 26 | $6.84 | $9.47 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.77 / $23.74 / $34.45
| Professional | TC | $16.77 | $23.74 | $34.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.62 / $24.62 / $24.62
| Professional | | $24.62 | $24.62 | $24.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.25 / $41.63 / $53.15
| Professional | | $37.25 | $41.63 | $53.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.89 / $12.69 / $15.38
| Professional | 26 | $9.89 | $12.69 | $15.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.05 / $31.26 / $38.03
| Professional | TC | $26.05 | $31.26 | $38.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $7.94 / $8.58
| Professional | 26 | $7.94 | $7.94 | $8.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $30.43 / $56.18
| Professional | | $19.27 | $30.43 | $56.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.41 / $9.64 / $16.27
| Professional | 26 | $5.41 | $9.64 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $38.29 / $38.29 / $38.29
| Professional | 50 | $38.29 | $38.29 | $38.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.86 / $22.15 / $39.92
| Professional | TC | $13.86 | $22.15 | $39.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $31.40 / $47.30
| Professional | | $21.26 | $31.40 | $47.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $9.05 / $14.64
| Professional | 26 | $6.74 | $9.05 | $14.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.81 / $22.69 / $33.25
| Professional | TC | $13.81 | $22.69 | $33.25 |