- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.32 / $20.98 / $24.03
| Facility | 26 | $11.32 | $20.98 | $24.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $30.07 / $86.27
| Professional | | $17.14 | $30.07 | $86.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.48 / $14.32 / $49.00
| Professional | 26 | $7.48 | $14.32 | $49.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.11 / $18.73 / $29.81
| Professional | TC | $10.11 | $18.73 | $29.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.16 / $18.19 / $49.28
| Professional | | $8.16 | $18.19 | $49.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $28.99 / $63.56
| Professional | | $21.51 | $28.99 | $63.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.30 / $12.25 / $23.01
| Professional | 26 | $8.30 | $12.25 | $23.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.25 / $16.80 / $38.77
| Professional | TC | $12.25 | $16.80 | $38.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.60 / $32.34 / $50.79
| Professional | | $18.60 | $32.34 | $50.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $34.42 / $93.95
| Professional | | $21.51 | $34.42 | $93.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.30 / $12.25 / $22.09
| Professional | 26 | $8.30 | $12.25 | $22.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.25 / $16.01 / $37.76
| Professional | TC | $12.25 | $16.01 | $37.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.37 / $35.84 / $85.16
| Professional | | $19.37 | $35.84 | $85.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $15.21 / $31.03
| Professional | 26 | $7.59 | $15.21 | $31.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.21 / $23.04 / $49.69
| Professional | TC | $11.21 | $23.04 | $49.69 |