- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.62 / $14.49 / $19.55
| Facility | 26 | $11.62 | $14.49 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.94 / $36.79 / $52.25
| Professional | | $29.94 | $36.79 | $52.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $10.90 / $15.21
| Professional | 26 | $8.86 | $10.90 | $15.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.07 / $25.89 / $37.04
| Professional | TC | $21.07 | $25.89 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.67 / $27.16 / $28.86
| Professional | | $25.67 | $27.16 | $28.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $8.71 / $15.79
| Professional | 26 | $7.90 | $8.71 | $15.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.42 / $54.00 / $63.72
| Professional | | $39.42 | $54.00 | $63.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.96 / $17.75 / $20.95
| Professional | 26 | $12.96 | $17.75 | $20.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.46 / $36.25 / $42.78
| Professional | TC | $26.46 | $36.25 | $42.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.16 / $12.16 / $12.27
| Facility | 26 | $12.16 | $12.16 | $12.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.35 / $40.45 / $92.81
| Professional | | $27.35 | $40.45 | $92.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.69 / $13.78 / $29.00
| Professional | 26 | $8.69 | $13.78 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.52 / $30.24 / $67.38
| Professional | TC | $20.52 | $30.24 | $67.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.46 / $37.03 / $50.08
| Professional | | $28.46 | $37.03 | $50.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.94 / $11.44 / $14.98
| Professional | 26 | $8.94 | $11.44 | $14.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.76 / $24.48 / $35.72
| Professional | TC | $19.76 | $24.48 | $35.72 |