- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $14.79 / $38.90
| Facility | 26 | $8.71 | $14.79 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $33.11 / $77.62
| Professional | | $23.99 | $33.11 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.00 / $25.12
| Professional | 26 | $7.08 | $10.00 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $21.88 / $45.71
| Professional | TC | $15.85 | $21.88 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $37.15 / $67.61
| Professional | | $26.92 | $37.15 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $12.30 / $21.38
| Professional | 26 | $9.33 | $12.30 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $25.12 / $46.77
| Professional | TC | $17.78 | $25.12 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.34 / $12.59 / $29.51
| Facility | 26 | $2.34 | $12.59 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $42.66 / $83.18
| Professional | | $25.70 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.49 / $26.30
| Professional | 26 | $7.94 | $13.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $28.84 / $60.26
| Professional | TC | $17.38 | $28.84 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.11 / $63.10
| Professional | | $25.12 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.72 / $19.95
| Professional | 26 | $7.94 | $10.72 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $22.91 / $42.66
| Professional | TC | $16.98 | $22.91 | $42.66 |