- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.37 / $3.70 / $3.71
| Facility | 26 | $2.37 | $3.70 | $3.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $17.55 / $26.80
| Professional | | $14.54 | $17.55 | $26.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.75 / $3.71 / $5.73
| Professional | 26 | $2.75 | $3.71 | $5.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $13.84 / $21.07
| Professional | TC | $11.75 | $13.84 | $21.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $14.41 / $14.41
| Professional | | $12.25 | $14.41 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.20 / $2.52 / $2.69
| Professional | 26 | $2.20 | $2.52 | $2.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $31.68 / $37.38
| Professional | | $15.84 | $31.68 | $37.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.95 / $5.93 / $7.00
| Professional | 26 | $2.95 | $5.93 | $7.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.89 / $25.75 / $30.39
| Professional | TC | $12.89 | $25.75 | $30.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.01 / $29.10 / $53.72
| Professional | | $17.01 | $29.10 | $53.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.26 / $6.88 / $11.42
| Professional | 26 | $3.26 | $6.88 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.14 / $21.95 / $44.21
| Professional | TC | $14.14 | $21.95 | $44.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $20.66 / $29.56
| Professional | | $15.24 | $20.66 | $29.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.28 / $4.55 / $6.81
| Professional | 26 | $3.28 | $4.55 | $6.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.73 / $16.25 / $23.46
| Professional | TC | $11.73 | $16.25 | $23.46 |