- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.59 / $14.41 / $26.89
| Facility | 26 | $11.59 | $14.41 | $26.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.39 / $42.02 / $78.05
| Professional | | $35.39 | $42.02 | $78.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.07 / $11.79 / $26.04
| Professional | 26 | $10.07 | $11.79 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.79 / $29.72 / $56.56
| Professional | TC | $24.79 | $29.72 | $56.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.27 / $13.27 / $13.27
| Facility | 26 | $13.27 | $13.27 | $13.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.06 / $48.90 / $80.11
| Professional | | $36.06 | $48.90 | $80.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.64 / $16.02 / $24.01
| Professional | 26 | $11.64 | $16.02 | $24.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.00 / $33.89 / $56.83
| Professional | TC | $24.00 | $33.89 | $56.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $13.50 / $13.50
| Facility | 26 | $13.50 | $13.50 | $13.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.26 / $52.95 / $92.39
| Professional | | $36.26 | $52.95 | $92.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.65 / $17.05 / $27.43
| Professional | 26 | $10.65 | $17.05 | $27.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.48 / $36.21 / $65.56
| Professional | TC | $24.48 | $36.21 | $65.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.72 / $46.39 / $81.06
| Professional | | $36.72 | $46.39 | $81.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.71 / $15.12 / $28.02
| Professional | 26 | $11.71 | $15.12 | $28.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.61 / $32.29 / $56.92
| Professional | TC | $24.61 | $32.29 | $56.92 |