- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.46 / $10.69 / $18.11
| Facility | 26 | $8.46 | $10.69 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.87 / $36.09 / $65.38
| Professional | | $29.87 | $36.09 | $65.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.51 / $8.68 / $18.52
| Professional | 26 | $7.51 | $8.68 | $18.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.94 / $27.11 / $51.90
| Professional | TC | $21.94 | $27.11 | $51.90 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.66 / $9.66 / $9.66
| Facility | 26 | $9.66 | $9.66 | $9.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.49 / $40.14 / $69.60
| Professional | | $30.49 | $40.14 | $69.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.41 / $11.85 / $17.55
| Professional | 26 | $8.41 | $11.85 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.85 / $29.11 / $52.99
| Professional | TC | $21.85 | $29.11 | $52.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.01 / $10.01 / $10.01
| Facility | 26 | $10.01 | $10.01 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.55 / $44.88 / $77.84
| Professional | | $29.55 | $44.88 | $77.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.89 / $12.43 / $20.10
| Professional | 26 | $7.89 | $12.43 | $20.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $32.26 / $60.82
| Professional | TC | $21.26 | $32.26 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.55 / $39.29 / $70.87
| Professional | | $29.55 | $39.29 | $70.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.41 / $10.35 / $18.72
| Professional | 26 | $8.41 | $10.35 | $18.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.97 / $29.27 / $52.80
| Professional | TC | $20.97 | $29.27 | $52.80 |