- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.00 / $10.82 / $14.65
| Facility | 26 | $9.00 | $10.82 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $39.79 / $65.38
| Professional | | $25.47 | $39.79 | $65.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.11 / $10.24 / $14.20
| Professional | 26 | $7.11 | $10.24 | $14.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.48 / $28.98 / $51.90
| Professional | TC | $19.48 | $28.98 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $9.14 / $9.56
| Professional | 26 | $8.13 | $9.14 | $9.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.29 / $49.21 / $62.65
| Professional | | $44.29 | $49.21 | $62.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.27 / $13.14 / $16.36
| Professional | 26 | $10.27 | $13.14 | $16.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.46 / $38.96 / $46.24
| Professional | TC | $32.46 | $38.96 | $46.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $7.94 / $8.89
| Professional | 26 | $7.94 | $7.94 | $8.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.49 / $35.22 / $66.23
| Professional | | $22.49 | $35.22 | $66.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.41 / $9.76 / $16.27
| Professional | 26 | $5.41 | $9.76 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.07 / $27.29 / $49.96
| Professional | TC | $17.07 | $27.29 | $49.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.63 / $37.17 / $57.57
| Professional | | $24.63 | $37.17 | $57.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.28 / $9.67 / $15.35
| Professional | 26 | $7.28 | $9.67 | $15.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.86 / $27.79 / $41.69
| Professional | TC | $16.86 | $27.79 | $41.69 |