- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $14.13 / $38.02
| Facility | 26 | $7.59 | $14.13 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $37.15 / $87.10
| Professional | | $25.70 | $37.15 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $8.91 / $24.55
| Professional | 26 | $7.08 | $8.91 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $28.18 / $61.66
| Professional | TC | $19.05 | $28.18 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $9.55 / $9.55
| Facility | 26 | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $38.90 / $74.13
| Professional | | $27.54 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $11.48 / $19.95
| Professional | 26 | $8.51 | $11.48 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $27.54 / $56.23
| Professional | TC | $18.62 | $27.54 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.14 / $11.22 / $27.54
| Facility | 26 | $2.14 | $11.22 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $45.71 / $97.72
| Professional | | $28.18 | $45.71 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $12.30 / $23.99
| Professional | 26 | $7.24 | $12.30 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $34.67 / $77.62
| Professional | TC | $20.42 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $37.15 / $72.44
| Professional | | $26.92 | $37.15 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $9.55 / $18.20
| Professional | 26 | $7.41 | $9.55 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $27.54 / $53.70
| Professional | TC | $19.50 | $27.54 | $53.70 |