- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.20 / $7.91 / $17.37
| Facility | 26 | $7.20 | $7.91 | $17.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.77 / $34.36 / $61.93
| Professional | | $25.77 | $34.36 | $61.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.21 / $8.55 / $17.37
| Professional | 26 | $7.21 | $8.55 | $17.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.55 / $23.21 / $44.56
| Professional | TC | $18.55 | $23.21 | $44.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.46 / $25.46 / $27.49
| Professional | | $25.46 | $25.46 | $27.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.12 / $7.68 / $13.17
| Professional | 26 | $6.12 | $7.68 | $13.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.26 / $25.26 / $25.26
| Professional | TC | $25.26 | $25.26 | $25.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.00 / $47.00 / $47.00
| Professional | | $47.00 | $47.00 | $47.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.89 / $41.88 / $58.52
| Professional | | $24.89 | $41.88 | $58.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.13 / $12.95 / $17.23
| Professional | 26 | $7.13 | $12.95 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.30 / $28.91 / $41.82
| Professional | TC | $17.30 | $28.91 | $41.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.99 / $32.34 / $32.34
| Professional | | $6.99 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.15 / $33.70 / $61.92
| Professional | | $24.15 | $33.70 | $61.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $10.19 / $18.09
| Professional | 26 | $7.03 | $10.19 | $18.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.91 / $22.83 / $42.82
| Professional | TC | $16.91 | $22.83 | $42.82 |