- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.23 / $10.39 / $14.02
| Facility | 26 | $8.23 | $10.39 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.97 / $27.00 / $38.36
| Professional | | $21.97 | $27.00 | $38.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.33 / $7.77 / $10.90
| Professional | 26 | $6.33 | $7.77 | $10.90 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $10.58 / $13.50 / $18.28
| Professional | 52 | $10.58 | $13.50 | $18.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.64 / $19.22 / $27.45
| Professional | TC | $15.64 | $19.22 | $27.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $20.72 / $28.97
| Professional | | $18.55 | $20.72 | $28.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.64 / $8.50 / $12.74
| Professional | 26 | $5.64 | $8.50 | $12.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.40 / $23.40 / $23.40
| Professional | TC | $23.40 | $23.40 | $23.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.11 / $38.50 / $45.43
| Professional | | $28.11 | $38.50 | $45.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.17 / $12.56 / $14.82
| Professional | 26 | $9.17 | $12.56 | $14.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.94 / $25.94 / $30.61
| Professional | TC | $18.94 | $25.94 | $30.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $8.61 / $8.69
| Facility | 26 | $8.61 | $8.61 | $8.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.01 / $29.71 / $68.20
| Professional | | $21.01 | $29.71 | $68.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.20 / $10.17 / $20.00
| Professional | 26 | $6.20 | $10.17 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.87 / $22.76 / $49.32
| Professional | TC | $15.87 | $22.76 | $49.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $26.38 / $35.63
| Professional | | $20.05 | $26.38 | $35.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.23 / $7.95 / $10.64
| Professional | 26 | $6.23 | $7.95 | $10.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.15 / $18.19 / $24.25
| Professional | TC | $14.15 | $18.19 | $24.25 |