- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.17 / $10.39 / $10.39
| Facility | 26 | $8.17 | $10.39 | $10.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.21 / $21.53 / $31.15
| Professional | | $18.21 | $21.53 | $31.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.04 / $7.29 / $10.39
| Professional | 26 | $6.04 | $7.29 | $10.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.17 / $14.78 / $20.76
| Professional | TC | $12.17 | $14.78 | $20.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.86 / $17.86 / $17.86
| Professional | | $17.86 | $17.86 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $1.44 / $6.58 / $13.89
| Professional | 26 | $1.44 | $6.58 | $13.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.82 / $34.00 / $40.11
| Professional | | $24.82 | $34.00 | $40.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.11 / $12.48 / $14.73
| Professional | 26 | $9.11 | $12.48 | $14.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.71 / $21.52 / $25.39
| Professional | TC | $15.71 | $21.52 | $25.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.55 / $8.55 / $8.61
| Facility | 26 | $8.55 | $8.55 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.25 / $25.66 / $51.60
| Professional | | $17.25 | $25.66 | $51.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.20 / $9.69 / $20.00
| Professional | 26 | $6.20 | $9.69 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.98 / $17.34 / $39.90
| Professional | TC | $11.98 | $17.34 | $39.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $22.58 / $30.71
| Professional | | $18.07 | $22.58 | $30.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.23 / $7.95 / $10.86
| Professional | 26 | $6.23 | $7.95 | $10.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.67 / $14.55 / $20.67
| Professional | TC | $11.67 | $14.55 | $20.67 |