- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $20.42 / $20.42
| Facility | 26 | $8.51 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $34.67 / $67.61
| Professional | | $16.98 | $34.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $17.38 / $38.02
| Professional | 26 | $10.00 | $17.38 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.00 / $25.12 / $46.77
| Professional | TC | $10.00 | $25.12 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.60 / $26.30
| Professional | 26 | $10.96 | $16.60 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $39.81 / $51.29
| Professional | | $28.18 | $39.81 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $15.49 / $19.95
| Professional | 26 | $10.96 | $15.49 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $24.55 / $30.90
| Professional | TC | $16.98 | $24.55 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $9.12
| Facility | 26 | $8.91 | $8.91 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $25.12 / $79.43
| Professional | | $13.80 | $25.12 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.30 / $33.11
| Professional | 26 | $7.94 | $12.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.32 / $16.98 / $54.95
| Professional | TC | $8.32 | $16.98 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $34.67 / $47.86
| Professional | | $16.60 | $34.67 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $13.49 / $18.62
| Professional | 26 | $6.76 | $13.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.12 / $22.39 / $30.20
| Professional | TC | $9.12 | $22.39 | $30.20 |