- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.27 / $11.28 / $15.22
| Facility | 26 | $11.27 | $11.28 | $15.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.81 / $34.40 / $50.62
| Professional | | $27.81 | $34.40 | $50.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.54 / $8.31 / $11.84
| Professional | 26 | $6.54 | $8.31 | $11.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $26.09 / $38.78
| Professional | TC | $21.26 | $26.09 | $38.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.45 / $27.45 / $67.84
| Professional | | $27.45 | $27.45 | $67.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.13 / $7.13 / $7.68
| Professional | 26 | $7.13 | $7.13 | $7.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.66 / $42.00 / $49.56
| Professional | | $30.66 | $42.00 | $49.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.67 / $11.88 / $14.02
| Professional | 26 | $8.67 | $11.88 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.99 / $30.12 / $35.54
| Professional | TC | $21.99 | $30.12 | $35.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $9.38 / $9.46
| Facility | 26 | $9.38 | $9.38 | $9.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $36.56 / $87.50
| Professional | | $25.82 | $36.56 | $87.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.49 / $10.95 / $23.00
| Professional | 26 | $6.49 | $10.95 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.34 / $28.42 / $70.52
| Professional | TC | $20.34 | $28.42 | $70.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $33.27 / $44.04
| Professional | | $25.77 | $33.27 | $44.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.77 / $8.64 / $12.10
| Professional | 26 | $6.77 | $8.64 | $12.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.53 / $24.63 / $31.40
| Professional | TC | $18.53 | $24.63 | $31.40 |