- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $15.83 / $15.84
| Facility | 26 | $10.80 | $15.83 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.60 / $40.50 / $56.52
| Professional | | $32.60 | $40.50 | $56.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.13 / $11.16 / $15.84
| Professional | 26 | $9.13 | $11.16 | $15.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.47 / $30.98 / $40.67
| Professional | TC | $23.47 | $30.98 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.50 / $31.50 / $31.50
| Professional | | $31.50 | $31.50 | $31.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.65 / $8.65 / $10.82
| Professional | 26 | $8.65 | $8.65 | $10.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.38 / $41.62 / $49.11
| Professional | | $30.38 | $41.62 | $49.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.88 / $12.17 / $14.36
| Professional | 26 | $8.88 | $12.17 | $14.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.50 / $29.45 / $34.75
| Professional | TC | $21.50 | $29.45 | $34.75 |
- 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
- $32.54 / $47.29 / $105.68
| Professional | | $32.54 | $47.29 | $105.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.51 / $13.78 / $29.00
| Professional | 26 | $9.51 | $13.78 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.06 / $37.75 / $76.81
| Professional | TC | $24.06 | $37.75 | $76.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.70 / $39.69 / $58.58
| Professional | | $31.70 | $39.69 | $58.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.03 / $12.12 / $15.16
| Professional | 26 | $9.03 | $12.12 | $15.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.28 / $27.52 / $44.64
| Professional | TC | $23.28 | $27.52 | $44.64 |