- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.56 / $13.56 / $18.30
| Facility | 26 | $13.56 | $13.56 | $18.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $32.92 / $46.48
| Professional | | $26.52 | $32.92 | $46.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.28 / $10.02 / $14.23
| Professional | 26 | $8.28 | $10.02 | $14.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.23 / $22.87 / $32.24
| Professional | TC | $18.23 | $22.87 | $32.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.35 / $33.25 / $62.46
| Professional | | $20.35 | $33.25 | $62.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $11.10 / $18.07
| Professional | 26 | $9.25 | $11.10 | $18.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.22 / $51.00 / $60.18
| Professional | | $37.22 | $51.00 | $60.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $18.05 / $21.30
| Professional | 26 | $13.18 | $18.05 | $21.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.05 / $32.95 / $38.88
| Professional | TC | $24.05 | $32.95 | $38.88 |
- 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
- $25.21 / $38.95 / $73.55
| Professional | | $25.21 | $38.95 | $73.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.11 / $14.33 / $29.00
| Professional | 26 | $8.11 | $14.33 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.48 / $27.48 / $57.96
| Professional | TC | $18.48 | $27.48 | $57.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.29 / $32.14 / $45.60
| Professional | | $25.29 | $32.14 | $45.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.39 / $10.72 / $15.01
| Professional | 26 | $8.39 | $10.72 | $15.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.43 / $22.29 / $31.89
| Professional | TC | $17.43 | $22.29 | $31.89 |