- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $8.84 / $11.58
| Facility | 26 | $8.84 | $8.84 | $11.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.83 / $32.39 / $42.40
| Professional | | $25.83 | $32.39 | $42.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.11 / $9.44 / $18.98
| Professional | 26 | $8.11 | $9.44 | $18.98 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.92 / $13.77 / $15.35
| Professional | 52 | $12.92 | $13.77 | $15.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $25.05 / $37.61
| Professional | TC | $16.98 | $25.05 | $37.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $10.18 / $10.18
| Professional | | $10.18 | $10.18 | $10.18 |
- 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
- $23.19 / $39.32 / $97.46
| Professional | | $23.19 | $39.32 | $97.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.45 / $14.36 / $47.74
| Professional | 26 | $7.45 | $14.36 | $47.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.74 / $33.78 / $93.56
| Professional | TC | $15.74 | $33.78 | $93.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.97 / $76.97 / $76.97
| Professional | | $76.97 | $76.97 | $76.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.75 / $15.38 / $23.89
| Professional | 26 | $13.75 | $15.38 | $23.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.89 / $39.36 / $72.84
| Professional | | $24.89 | $39.36 | $72.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.01 / $13.79 / $71.95
| Professional | 26 | $8.01 | $13.79 | $71.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.11 / $27.02 / $50.44
| Professional | TC | $17.11 | $27.02 | $50.44 |