- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $11.19 / $20.32
| Facility | 26 | $8.84 | $11.19 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.90 / $34.52 / $59.22
| Professional | | $24.90 | $34.52 | $59.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.99 / $10.15 / $19.19
| Professional | 26 | $7.99 | $10.15 | $19.19 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $11.75 / $14.02 / $21.00
| Professional | 52 | $11.75 | $14.02 | $21.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.76 / $25.05 / $41.03
| Professional | TC | $16.76 | $25.05 | $41.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.11 / $11.11 / $11.11
| Facility | 26 | $11.11 | $11.11 | $11.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.14 / $38.83 / $60.32
| Professional | | $28.14 | $38.83 | $60.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.75 / $12.81 / $18.87
| Professional | 26 | $8.75 | $12.81 | $18.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.41 / $27.48 / $42.82
| Professional | TC | $19.41 | $27.48 | $42.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $10.36 / $10.36
| Facility | 26 | $10.36 | $10.36 | $10.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.85 / $43.96 / $73.45
| Professional | | $26.85 | $43.96 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.94 / $13.48 / $22.09
| Professional | 26 | $8.94 | $13.48 | $22.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.01 / $31.15 / $52.77
| Professional | TC | $20.01 | $31.15 | $52.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $38.43 / $67.58
| Professional | | $30.17 | $38.43 | $67.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $11.69 / $22.45
| Professional | 26 | $9.25 | $11.69 | $22.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.28 / $27.02 / $47.60
| Professional | TC | $20.28 | $27.02 | $47.60 |