- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $11.22 / $28.84
| Facility | 26 | $7.08 | $11.22 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $42.66 / $125.89
| Professional | | $28.18 | $42.66 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $12.02 / $30.20
| Professional | 26 | $7.08 | $12.02 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $30.90 / $69.18
| Professional | TC | $20.89 | $30.90 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $9.33 / $9.33
| Facility | 26 | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $38.02 / $74.13
| Professional | | $28.18 | $38.02 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $10.96 / $19.05
| Professional | 26 | $7.24 | $10.96 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $28.84 / $57.54
| Professional | TC | $19.50 | $28.84 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.04 / $10.96 / $25.12
| Facility | 26 | $2.04 | $10.96 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $44.67 / $95.50
| Professional | | $27.54 | $44.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $11.75 / $22.91
| Professional | 26 | $6.92 | $11.75 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $34.67 / $75.86
| Professional | TC | $20.89 | $34.67 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $37.15 / $70.79
| Professional | | $26.92 | $37.15 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.33 / $17.38
| Professional | 26 | $7.08 | $9.33 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $27.54 / $53.70
| Professional | TC | $19.50 | $27.54 | $53.70 |