- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $29.58
| Facility | 26 | $11.22 | $11.22 | $29.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.76 / $34.93 / $51.07
| Professional | | $29.76 | $34.93 | $51.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.53 / $8.25 / $11.22
| Professional | 26 | $6.53 | $8.25 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.26 / $27.47 / $39.84
| Professional | TC | $22.26 | $27.47 | $39.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.09 / $34.22 / $45.34
| Professional | | $29.09 | $34.22 | $45.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.09 / $6.09 / $9.08
| Professional | 26 | $6.09 | $6.09 | $9.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.85 / $45.00 / $53.10
| Professional | | $32.85 | $45.00 | $53.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.52 / $11.69 / $13.79
| Professional | 26 | $8.52 | $11.69 | $13.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.32 / $33.31 / $39.31
| Professional | TC | $24.32 | $33.31 | $39.31 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.73 / $9.73 / $9.82
| Facility | 26 | $9.73 | $9.73 | $9.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.73 / $38.40 / $93.14
| Professional | | $26.73 | $38.40 | $93.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.68 / $11.75 / $23.00
| Professional | 26 | $6.68 | $11.75 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.03 / $29.59 / $74.45
| Professional | TC | $20.03 | $29.59 | $74.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.17 / $35.47 / $47.21
| Professional | | $23.17 | $35.47 | $47.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.79 / $8.60 / $12.09
| Professional | 26 | $6.79 | $8.60 | $12.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.10 / $26.88 / $34.35
| Professional | TC | $19.10 | $26.88 | $34.35 |