- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.73 / $16.51 / $18.45
| Facility | 26 | $12.73 | $16.51 | $18.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.97 / $48.95 / $78.70
| Professional | | $37.97 | $48.95 | $78.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.39 / $14.88 / $20.81
| Professional | 26 | $10.39 | $14.88 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.23 / $34.22 / $59.42
| Professional | TC | $27.23 | $34.22 | $59.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $31.82 / $31.82
| Professional | | $31.82 | $31.82 | $31.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.58 / $11.58 / $28.25
| Professional | 26 | $11.58 | $11.58 | $28.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.89 / $60.32 / $72.52
| Professional | | $53.89 | $60.32 | $72.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.58 / $18.70 / $23.79
| Professional | 26 | $14.58 | $18.70 | $23.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.08 / $43.62 / $53.82
| Professional | TC | $38.08 | $43.62 | $53.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.29 / $12.20 / $30.80
| Professional | 26 | $11.29 | $12.20 | $30.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.24 / $44.91 / $81.92
| Professional | | $27.24 | $44.91 | $81.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.70 / $13.89 / $23.32
| Professional | 26 | $7.70 | $13.89 | $23.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.54 / $34.26 / $58.77
| Professional | TC | $19.54 | $34.26 | $58.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.86 / $46.56 / $73.01
| Professional | | $33.86 | $46.56 | $73.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.59 / $14.05 / $21.35
| Professional | 26 | $10.59 | $14.05 | $21.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.48 / $32.85 / $54.62
| Professional | TC | $22.48 | $32.85 | $54.62 |