- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.28 / $13.95 / $14.51
| Facility | 26 | $12.28 | $13.95 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.35 / $37.79 / $82.03
| Professional | | $37.35 | $37.79 | $82.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.90 / $12.42 / $30.26
| Professional | 26 | $11.90 | $12.42 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.07 / $25.37 / $55.13
| Professional | TC | $25.07 | $25.37 | $55.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.70 / $32.24 / $57.67
| Professional | | $14.70 | $32.24 | $57.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $44.59 / $71.53
| Professional | | $27.54 | $44.59 | $71.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.95 / $20.14 / $27.66
| Professional | 26 | $13.95 | $20.14 | $27.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.14 / $28.87 / $39.89
| Professional | TC | $13.14 | $28.87 | $39.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.90 / $33.90 / $80.00
| Facility | 26 | $33.90 | $33.90 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.94 / $39.08 / $90.45
| Professional | | $26.94 | $39.08 | $90.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.70 / $16.32 / $93.99
| Professional | 26 | $12.70 | $16.32 | $93.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.18 / $22.20 / $212.11
| Professional | TC | $11.18 | $22.20 | $212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.85 / $37.03 / $67.06
| Professional | | $25.85 | $37.03 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.70 / $15.88 / $24.67
| Professional | 26 | $12.70 | $15.88 | $24.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.15 / $21.47 / $39.10
| Professional | TC | $11.15 | $21.47 | $39.10 |