- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.58 / $16.26 / $21.97
| Facility | 26 | $13.58 | $16.26 | $21.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $47.27 / $76.14
| Professional | | $34.85 | $47.27 | $76.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $15.43 / $21.15
| Professional | 26 | $10.97 | $15.43 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $14.70 / $24.12 / $33.89
| Professional | 52 | $14.70 | $24.12 | $33.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.26 / $31.98 / $55.94
| Professional | TC | $22.26 | $31.98 | $55.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.18 / $12.18 / $14.35
| Professional | 26 | $12.18 | $12.18 | $14.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.73 / $58.12 / $69.16
| Professional | | $51.73 | $58.12 | $69.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.42 / $19.67 / $25.78
| Professional | 26 | $15.42 | $19.67 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.61 / $38.45 / $45.57
| Professional | TC | $34.61 | $38.45 | $45.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.89 / $11.89 / $12.82
| Professional | 26 | $11.89 | $11.89 | $12.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.50 / $43.11 / $78.33
| Professional | | $26.50 | $43.11 | $78.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.10 / $14.86 / $24.86
| Professional | 26 | $8.10 | $14.86 | $24.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.39 / $29.41 / $53.87
| Professional | TC | $18.39 | $29.41 | $53.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.88 / $44.75 / $72.00
| Professional | | $31.88 | $44.75 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.95 / $14.52 / $23.35
| Professional | 26 | $10.95 | $14.52 | $23.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.01 / $29.14 / $46.02
| Professional | TC | $17.01 | $29.14 | $46.02 |