- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.62 / $14.44 / $19.48
| Facility | 26 | $11.62 | $14.44 | $19.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.85 / $46.61 / $54.37
| Professional | | $29.85 | $46.61 | $54.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $10.15 / $15.16
| Professional | 26 | $8.34 | $10.15 | $15.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.51 / $36.57 / $39.21
| Professional | TC | $21.51 | $36.57 | $39.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.54 / $41.54 / $41.54
| Professional | | $41.54 | $41.54 | $41.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.86 / $13.02 / $13.02
| Professional | 26 | $7.86 | $13.02 | $13.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.74 / $69.50 / $82.01
| Professional | | $50.74 | $69.50 | $82.01 |
- 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
- $37.56 / $51.45 / $60.71
| Professional | TC | $37.56 | $51.45 | $60.71 |
- 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
- $30.70 / $47.19 / $96.86
| Professional | | $30.70 | $47.19 | $96.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.66 / $14.66 / $29.00
| Professional | 26 | $8.66 | $14.66 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.72 / $34.22 / $70.52
| Professional | TC | $22.72 | $34.22 | $70.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.85 / $38.06 / $60.29
| Professional | | $30.85 | $38.06 | $60.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.67 / $11.04 / $15.51
| Professional | 26 | $8.67 | $11.04 | $15.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.95 / $27.08 / $47.00
| Professional | TC | $21.95 | $27.08 | $47.00 |