- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.03 / $10.09 / $15.55
| Facility | 26 | $8.03 | $10.09 | $15.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.89 / $36.65 / $76.31
| Professional | | $29.89 | $36.65 | $76.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.30 / $8.55 / $21.62
| Professional | 26 | $7.30 | $8.55 | $21.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.57 / $27.65 / $55.04
| Professional | TC | $22.57 | $27.65 | $55.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.31 / $40.61 / $67.72
| Professional | | $30.31 | $40.61 | $67.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.09 / $11.39 / $16.89
| Professional | 26 | $8.09 | $11.39 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.08 / $29.85 / $53.18
| Professional | TC | $23.08 | $29.85 | $53.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.52 / $43.79 / $77.79
| Professional | | $29.52 | $43.79 | $77.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.42 / $11.92 / $19.27
| Professional | 26 | $7.42 | $11.92 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.65 / $32.79 / $60.82
| Professional | TC | $21.65 | $32.79 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.65 / $39.15 / $69.36
| Professional | | $29.65 | $39.15 | $69.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.09 / $10.30 / $18.00
| Professional | 26 | $8.09 | $10.30 | $18.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.54 / $28.65 / $52.19
| Professional | TC | $21.54 | $28.65 | $52.19 |