- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.76 / $10.11 / $15.78
| Facility | 26 | $8.76 | $10.11 | $15.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.15 / $58.97 / $124.39
| Professional | | $52.15 | $58.97 | $124.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.66 / $9.28 / $25.10
| Professional | 26 | $7.66 | $9.28 | $25.10 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $25.20 / $28.78 / $37.97
| Professional | 52 | $25.20 | $28.78 | $37.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.31 / $49.36 / $82.01
| Professional | TC | $43.31 | $49.36 | $82.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.43 / $66.31 / $108.05
| Professional | | $51.43 | $66.31 | $108.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.68 / $9.82 / $16.47
| Professional | 26 | $7.68 | $9.82 | $16.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.70 / $56.18 / $91.13
| Professional | TC | $43.70 | $56.18 | $91.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.06 / $10.06 / $10.06
| Facility | 26 | $10.06 | $10.06 | $10.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.49 / $75.79 / $133.25
| Professional | | $55.49 | $75.79 | $133.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $11.92 / $20.00
| Professional | 26 | $8.90 | $11.92 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.25 / $63.81 / $111.77
| Professional | TC | $46.25 | $63.81 | $111.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.87 / $64.70 / $110.00
| Professional | | $48.87 | $64.70 | $110.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $10.33 / $17.46
| Professional | 26 | $7.97 | $10.33 | $17.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.23 / $55.36 / $91.57
| Professional | TC | $41.23 | $55.36 | $91.57 |