- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.21 / $9.02 / $13.37
| Facility | 26 | $8.21 | $9.02 | $13.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.11 / $33.49 / $64.37
| Professional | | $28.11 | $33.49 | $64.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.50 / $8.94 / $18.18
| Professional | 26 | $7.50 | $8.94 | $18.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.39 / $23.70 / $46.85
| Professional | TC | $20.39 | $23.70 | $46.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $9.46 / $9.46
| Professional | | $9.46 | $9.46 | $9.46 |
- 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
- $25.79 / $43.15 / $151.25
| Professional | | $25.79 | $43.15 | $151.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.91 / $12.22 / $40.40
| Professional | 26 | $6.91 | $12.22 | $40.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.88 / $31.35 / $112.26
| Professional | TC | $18.88 | $31.35 | $112.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.38 / $85.10 / $85.82
| Professional | | $84.38 | $85.10 | $85.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.03 / $14.20 / $21.75
| Professional | 26 | $13.03 | $14.20 | $21.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.78 / $36.79 / $65.95
| Professional | | $20.78 | $36.79 | $65.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.66 / $10.79 / $20.56
| Professional | 26 | $5.66 | $10.79 | $20.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.18 / $27.33 / $45.45
| Professional | TC | $16.18 | $27.33 | $45.45 |