- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.41 / $12.27 / $14.62
| Facility | 26 | $11.41 | $12.27 | $14.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.30 / $38.63 / $65.38
| Professional | | $29.30 | $38.63 | $65.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $11.28 / $13.48
| Professional | 26 | $7.08 | $11.28 | $13.48 |
- 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
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.01 / $14.01 / $14.01
| Professional | 26 | $14.01 | $14.01 | $14.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.90 / $46.19 / $51.32
| Professional | | $34.90 | $46.19 | $51.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.98 / $13.20 / $14.67
| Professional | 26 | $9.98 | $13.20 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.92 / $32.99 / $36.65
| Professional | TC | $24.92 | $32.99 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.49 / $43.85 / $65.20
| Professional | | $30.49 | $43.85 | $65.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $12.51 / $16.98
| Professional | 26 | $8.34 | $12.51 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.98 / $30.00 / $47.50
| Professional | TC | $20.98 | $30.00 | $47.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.79 / $15.79 / $16.11
| Professional | 26 | $15.79 | $15.79 | $16.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $37.38 / $67.34
| Professional | | $30.20 | $37.38 | $67.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.44 / $10.32 / $17.16
| Professional | 26 | $8.44 | $10.32 | $17.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.19 / $28.50 / $51.22
| Professional | TC | $20.19 | $28.50 | $51.22 |