- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.65 / $11.98 / $21.06
| Facility | 26 | $9.65 | $11.98 | $21.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.67 / $19.26 / $32.14
| Professional | | $15.67 | $19.26 | $32.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.61 / $9.73 / $18.32
| Professional | 26 | $8.61 | $9.73 | $18.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.93 / $10.11 / $15.39
| Professional | TC | $6.93 | $10.11 | $15.39 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.10 / $12.10 / $12.10
| Facility | 26 | $12.10 | $12.10 | $12.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $25.47 / $45.37
| Professional | | $18.55 | $25.47 | $45.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $13.25 / $19.94
| Professional | 26 | $9.86 | $13.25 | $19.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.73 / $12.14 / $24.99
| Professional | TC | $8.73 | $12.14 | $24.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $11.16 / $11.16
| Facility | 26 | $11.16 | $11.16 | $11.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.17 / $29.01 / $49.09
| Professional | | $17.17 | $29.01 | $49.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.94 / $14.34 / $23.51
| Professional | 26 | $8.94 | $14.34 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.23 / $14.26 / $26.68
| Professional | TC | $8.23 | $14.26 | $26.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $25.34 / $42.45
| Professional | | $18.43 | $25.34 | $42.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.31 / $12.22 / $21.69
| Professional | 26 | $9.31 | $12.22 | $21.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.32 / $11.56 / $21.92
| Professional | TC | $8.32 | $11.56 | $21.92 |