- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.85 / $13.03 / $13.04
| Facility | 26 | $8.85 | $13.03 | $13.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.66 / $29.33 / $40.85
| Professional | | $23.66 | $29.33 | $40.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.56 / $9.61 / $13.20
| Professional | 26 | $7.56 | $9.61 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.10 / $19.72 / $27.81
| Professional | TC | $16.10 | $19.72 | $27.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $19.14 / $19.14
| Professional | | $19.14 | $19.14 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.23 / $8.23 / $8.86
| Professional | 26 | $8.23 | $8.23 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.20 / $40.00 / $47.20
| Professional | | $29.20 | $40.00 | $47.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.90 / $14.93 / $17.62
| Professional | 26 | $10.90 | $14.93 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.30 / $25.07 / $29.58
| Professional | TC | $18.30 | $25.07 | $29.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.21 / $10.21 / $10.30
| Facility | 26 | $10.21 | $10.21 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.26 / $34.18 / $77.04
| Professional | | $22.26 | $34.18 | $77.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.56 / $12.70 / $24.00
| Professional | 26 | $7.56 | $12.70 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.32 / $23.25 / $53.25
| Professional | TC | $16.32 | $23.25 | $53.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.82 / $28.86 / $39.96
| Professional | | $23.82 | $28.86 | $39.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.85 / $10.00 / $13.68
| Professional | 26 | $7.85 | $10.00 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.05 / $19.16 / $27.69
| Professional | TC | $15.05 | $19.16 | $27.69 |