- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $12.59 / $33.88
| Facility | 26 | $7.41 | $12.59 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $33.88 / $97.72
| Professional | | $24.55 | $33.88 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $8.91 / $24.55
| Professional | 26 | $6.61 | $8.91 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $23.99 / $56.23
| Professional | TC | $16.98 | $23.99 | $56.23 |
- 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
- $26.92 / $37.15 / $67.61
| Professional | | $26.92 | $37.15 | $67.61 |
- 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
- $19.95 / $26.30 / $48.98
| Professional | TC | $19.95 | $26.30 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.04 / $10.96 / $26.30
| Facility | 26 | $2.04 | $10.96 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $41.69 / $85.11
| Professional | | $25.12 | $41.69 | $85.11 |
- 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
- $18.62 / $30.90 / $66.07
| Professional | TC | $18.62 | $30.90 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.11 / $63.10
| Professional | | $25.12 | $33.11 | $63.10 |
- 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
- $17.78 / $23.44 / $44.67
| Professional | TC | $17.78 | $23.44 | $44.67 |