- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $12.49 / $20.34
| Facility | 26 | $9.33 | $12.49 | $20.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.05 / $31.12 / $56.88
| Professional | | $25.05 | $31.12 | $56.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $9.61 / $17.82
| Professional | 26 | $8.13 | $9.61 | $17.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.48 / $21.66 / $38.04
| Professional | TC | $17.48 | $21.66 | $38.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.11 / $11.11 / $11.11
| Facility | 26 | $11.11 | $11.11 | $11.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.83 / $35.84 / $59.78
| Professional | | $28.83 | $35.84 | $59.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.48 / $12.80 / $19.32
| Professional | 26 | $9.48 | $12.80 | $19.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.97 / $25.38 / $41.30
| Professional | TC | $18.97 | $25.38 | $41.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.79 / $10.79 / $10.79
| Facility | 26 | $10.79 | $10.79 | $10.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.26 / $41.98 / $68.45
| Professional | | $28.26 | $41.98 | $68.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.65 / $13.75 / $22.32
| Professional | 26 | $8.65 | $13.75 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.12 / $28.36 / $47.35
| Professional | TC | $19.12 | $28.36 | $47.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.61 / $35.46 / $60.34
| Professional | | $28.61 | $35.46 | $60.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $11.52 / $20.16
| Professional | 26 | $8.90 | $11.52 | $20.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.98 / $24.05 / $40.72
| Professional | TC | $18.98 | $24.05 | $40.72 |