- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.74 / $11.74 / $11.74
| Facility | 26 | $11.74 | $11.74 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.07 / $33.34 / $48.68
| Professional | | $28.07 | $33.34 | $48.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.81 / $8.25 / $11.74
| Professional | 26 | $6.81 | $8.25 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $25.13 / $36.94
| Professional | TC | $21.26 | $25.13 | $36.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.64 / $69.64 / $69.64
| Professional | | $69.64 | $69.64 | $69.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.03 / $35.65 / $42.08
| Professional | | $26.03 | $35.65 | $42.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.57 / $9.00 / $10.62
| Professional | 26 | $6.57 | $9.00 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $26.66 / $31.46
| Professional | TC | $19.46 | $26.66 | $31.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.78 / $9.78 / $9.88
| Facility | 26 | $9.78 | $9.78 | $9.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.06 / $37.88 / $90.17
| Professional | | $26.06 | $37.88 | $90.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.02 / $11.51 / $21.38
| Professional | 26 | $7.02 | $11.51 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.34 / $28.85 / $70.52
| Professional | TC | $20.34 | $28.85 | $70.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.08 / $33.64 / $44.58
| Professional | | $25.08 | $33.64 | $44.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.04 / $9.00 / $12.09
| Professional | 26 | $7.04 | $9.00 | $12.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.87 / $24.64 / $33.21
| Professional | TC | $17.87 | $24.64 | $33.21 |