- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.50 / $12.67 / $17.11
| Facility | 26 | $10.50 | $12.67 | $17.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.07 / $46.71 / $86.79
| Professional | | $29.07 | $46.71 | $86.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.74 / $9.40 / $13.31
| Professional | 26 | $7.74 | $9.40 | $13.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.33 / $34.03 / $77.39
| Professional | TC | $21.33 | $34.03 | $77.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $28.75 / $45.03
| Professional | | $23.16 | $28.75 | $45.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.90 / $6.92 / $11.42
| Professional | 26 | $6.90 | $6.92 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.74 / $84.58 / $99.80
| Professional | | $61.74 | $84.58 | $99.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.95 / $15.00 / $17.70
| Professional | 26 | $10.95 | $15.00 | $17.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.79 / $69.58 / $82.10
| Professional | TC | $50.79 | $69.58 | $82.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.98 / $10.98 / $11.07
| Facility | 26 | $10.98 | $10.98 | $11.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.04 / $52.26 / $139.91
| Professional | | $30.04 | $52.26 | $139.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $12.85 / $26.00
| Professional | 26 | $7.59 | $12.85 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.46 / $44.61 / $122.79
| Professional | TC | $22.46 | $44.61 | $122.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.85 / $38.06 / $117.97
| Professional | | $30.85 | $38.06 | $117.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.75 / $9.72 / $13.17
| Professional | 26 | $6.75 | $9.72 | $13.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.06 / $29.59 / $102.96
| Professional | TC | $23.06 | $29.59 | $102.96 |