- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $9.85 / $18.14
| Facility | 26 | $8.13 | $9.85 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.48 / $32.22 / $64.37
| Professional | | $26.48 | $32.22 | $64.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.23 / $8.53 / $17.23
| Professional | 26 | $7.23 | $8.53 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.23 / $23.21 / $44.56
| Professional | TC | $19.23 | $23.21 | $44.56 |
- 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
- $28.83 / $36.21 / $60.05
| Professional | | $28.83 | $36.21 | $60.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.09 / $11.36 / $16.89
| Professional | 26 | $8.09 | $11.36 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.79 / $26.88 / $44.33
| Professional | TC | $20.79 | $26.88 | $44.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.61 / $9.61 / $9.61
| Facility | 26 | $9.61 | $9.61 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.91 / $42.00 / $69.05
| Professional | | $27.91 | $42.00 | $69.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.58 / $11.92 / $19.27
| Professional | 26 | $7.58 | $11.92 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.20 / $30.02 / $50.96
| Professional | TC | $20.20 | $30.02 | $50.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.66 / $34.54 / $59.83
| Professional | | $28.66 | $34.54 | $59.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $10.05 / $17.96
| Professional | 26 | $7.95 | $10.05 | $17.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.16 / $25.42 / $43.55
| Professional | TC | $20.16 | $25.42 | $43.55 |