- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.31 / $7.31 / $15.39
| Facility | 26 | $7.31 | $7.31 | $15.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.82 / $33.08 / $75.69
| Professional | | $23.82 | $33.08 | $75.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.31 / $9.98 / $21.76
| Professional | 26 | $7.31 | $9.98 | $21.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.51 / $22.99 / $41.81
| Professional | TC | $16.51 | $22.99 | $41.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $21.95 / $45.84
| Professional | | $6.73 | $21.95 | $45.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $38.18 / $55.15
| Professional | | $27.05 | $38.18 | $55.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.24 / $12.62 / $17.57
| Professional | 26 | $8.24 | $12.62 | $17.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.82 / $25.56 / $37.09
| Professional | TC | $18.82 | $25.56 | $37.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $32.34 / $37.61
| Professional | | $11.92 | $32.34 | $37.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.22 / $48.67 / $71.80
| Professional | | $29.22 | $48.67 | $71.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.24 / $12.70 / $17.57
| Professional | 26 | $8.24 | $12.70 | $17.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.78 / $27.53 / $37.09
| Professional | TC | $18.78 | $27.53 | $37.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.57 / $31.83 / $71.89
| Professional | | $29.57 | $31.83 | $71.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.32 / $10.47 / $22.92
| Professional | 26 | $9.32 | $10.47 | $22.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.19 / $22.73 / $47.28
| Professional | TC | $20.19 | $22.73 | $47.28 |