- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.25 / $12.16 / $12.16
| Facility | 26 | $8.25 | $12.16 | $12.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.94 / $34.52 / $36.24
| Professional | | $20.94 | $34.52 | $36.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.05 / $9.44 / $12.16
| Professional | 26 | $7.05 | $9.44 | $12.16 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.47 / $13.38 / $18.12
| Professional | 52 | $10.47 | $13.38 | $18.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.89 / $24.08 / $25.05
| Professional | TC | $13.89 | $24.08 | $25.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $19.00 / $19.00
| Professional | | $19.00 | $19.00 | $19.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.95 / $34.18 / $40.33
| Professional | | $24.95 | $34.18 | $40.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.49 / $10.26 / $12.11
| Professional | 26 | $7.49 | $10.26 | $12.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.46 / $23.92 / $28.23
| Professional | TC | $17.46 | $23.92 | $28.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.33 / $11.33 / $11.43
| Facility | 26 | $11.33 | $11.33 | $11.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.87 / $39.22 / $70.84
| Professional | | $22.87 | $39.22 | $70.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.28 / $13.10 / $27.00
| Professional | 26 | $7.28 | $13.10 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.59 / $28.29 / $51.03
| Professional | TC | $15.59 | $28.29 | $51.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.82 / $30.17 / $46.43
| Professional | | $23.82 | $30.17 | $46.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.50 / $9.32 / $14.02
| Professional | 26 | $7.50 | $9.32 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.73 / $20.92 / $32.90
| Professional | TC | $16.73 | $20.92 | $32.90 |