- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.05 / $13.56 / $21.83
| Facility | 26 | $10.05 | $13.56 | $21.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.89 / $38.92 / $74.20
| Professional | | $31.89 | $38.92 | $74.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.26 / $11.23 / $21.68
| Professional | 26 | $9.26 | $11.23 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.67 / $27.69 / $50.76
| Professional | TC | $22.67 | $27.69 | $50.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.27 / $13.27 / $13.27
| Facility | 26 | $13.27 | $13.27 | $13.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $43.72 / $75.25
| Professional | | $35.54 | $43.72 | $75.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.08 / $14.71 / $22.43
| Professional | 26 | $10.08 | $14.71 | $22.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.51 / $31.02 / $51.72
| Professional | TC | $24.51 | $31.02 | $51.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.95 / $11.95 / $11.95
| Facility | 26 | $11.95 | $11.95 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $51.54 / $84.81
| Professional | | $34.07 | $51.54 | $84.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.02 / $15.79 / $26.42
| Professional | 26 | $10.02 | $15.79 | $26.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.95 / $35.70 / $59.72
| Professional | TC | $23.95 | $35.70 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.45 / $43.70 / $80.04
| Professional | | $34.45 | $43.70 | $80.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.74 / $13.24 / $24.32
| Professional | 26 | $10.74 | $13.24 | $24.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.30 / $30.04 / $52.12
| Professional | TC | $23.30 | $30.04 | $52.12 |