- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.27 / $11.27 / $11.28
| Facility | 26 | $11.27 | $11.27 | $11.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.63 / $28.20 / $41.16
| Professional | | $23.63 | $28.20 | $41.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.54 / $7.91 / $11.28
| Professional | 26 | $6.54 | $7.91 | $11.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.09 / $20.39 / $29.89
| Professional | TC | $17.09 | $20.39 | $29.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.89 / $23.63 / $58.26
| Professional | | $18.89 | $23.63 | $58.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.12 / $6.12 / $7.68
| Professional | 26 | $6.12 | $6.12 | $7.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.19 / $27.19 / $27.19
| Professional | TC | $27.19 | $27.19 | $27.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.28 / $36.00 / $42.48
| Professional | | $26.28 | $36.00 | $42.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.22 / $11.26 / $13.29
| Professional | 26 | $8.22 | $11.26 | $13.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.05 / $24.74 / $29.19
| Professional | TC | $18.05 | $24.74 | $29.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $9.38 / $9.46
| Facility | 26 | $9.38 | $9.38 | $9.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.81 / $34.83 / $76.92
| Professional | | $22.81 | $34.83 | $76.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $11.04 / $23.00
| Professional | 26 | $6.74 | $11.04 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.86 / $25.65 / $56.39
| Professional | TC | $17.86 | $25.65 | $56.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.55 / $28.56 / $39.09
| Professional | | $23.55 | $28.56 | $39.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.77 / $8.64 / $11.60
| Professional | 26 | $6.77 | $8.64 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.39 / $20.14 / $28.11
| Professional | TC | $16.39 | $20.14 | $28.11 |