- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.75 / $17.28 / $22.47
| Facility | 26 | $13.75 | $17.28 | $22.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.01 / $49.74 / $80.29
| Professional | | $37.01 | $49.74 | $80.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.12 / $15.66 / $21.92
| Professional | 26 | $11.12 | $15.66 | $21.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.89 / $34.22 / $59.42
| Professional | TC | $25.89 | $34.22 | $59.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $9.86 / $9.86
| Professional | 26 | $9.86 | $9.86 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.68 / $61.43 / $73.23
| Professional | | $54.68 | $61.43 | $73.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.76 / $20.21 / $25.09
| Professional | 26 | $15.76 | $20.21 | $25.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.72 / $43.21 / $53.82
| Professional | TC | $37.72 | $43.21 | $53.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.20 / $12.20 / $12.87
| Professional | 26 | $12.20 | $12.20 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $45.57 / $83.79
| Professional | | $27.86 | $45.57 | $83.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $15.01 / $25.02
| Professional | 26 | $8.32 | $15.01 | $25.02 |
- 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
- $34.44 / $47.93 / $74.25
| Professional | | $34.44 | $47.93 | $74.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $14.51 / $23.35
| Professional | 26 | $11.16 | $14.51 | $23.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.20 / $33.07 / $50.02
| Professional | TC | $23.20 | $33.07 | $50.02 |