- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.50 / $25.74 / $43.32
| Facility | 26 | $23.50 | $25.74 | $43.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.25 / $37.10 / $62.63
| Professional | | $33.25 | $37.10 | $62.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.44 / $24.53 / $43.32
| Professional | 26 | $21.44 | $24.53 | $43.32 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.05 / $18.60 / $31.32
| Professional | 52 | $17.05 | $18.60 | $31.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.61 / $12.55 / $19.30
| Professional | TC | $10.61 | $12.55 | $19.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.85 / $34.92 / $38.99
| Professional | | $27.85 | $34.92 | $38.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.00 / $25.68 / $50.40
| Professional | 26 | $25.00 | $25.68 | $50.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.00 / $114.00 / $114.00
| Professional | | $114.00 | $114.00 | $114.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.07 / $44.07 / $62.83
| Professional | | $32.07 | $44.07 | $62.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.27 / $30.20 / $43.14
| Professional | 26 | $22.27 | $30.20 | $43.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.24 / $13.78 / $19.62
| Professional | TC | $10.24 | $13.78 | $19.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $32.34 / $32.34
| Professional | | $27.54 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.15 / $36.40 / $57.55
| Professional | | $29.15 | $36.40 | $57.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.04 / $25.46 / $40.82
| Professional | 26 | $20.04 | $25.46 | $40.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.15 / $11.59 / $17.89
| Professional | TC | $9.15 | $11.59 | $17.89 |