- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $11.48 / $28.84
| Facility | 26 | $7.41 | $11.48 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $37.15 / $112.20
| Professional | | $23.99 | $37.15 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $13.80 / $36.31
| Professional | 26 | $7.08 | $13.80 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $23.99 / $58.88
| Professional | TC | $15.85 | $23.99 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $8.91
| Facility | 26 | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $33.11 / $63.10
| Professional | | $21.38 | $33.11 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $11.22 / $19.50
| Professional | 26 | $6.31 | $11.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.79 / $21.88 / $44.67
| Professional | TC | $14.79 | $21.88 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.14 / $11.22 / $27.54
| Facility | 26 | $2.14 | $11.22 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $38.02 / $79.43
| Professional | | $23.44 | $38.02 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $11.75 / $23.44
| Professional | 26 | $7.08 | $11.75 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $26.92 / $60.26
| Professional | TC | $16.60 | $26.92 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $30.90 / $60.26
| Professional | | $22.91 | $30.90 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.33 / $17.78
| Professional | 26 | $7.08 | $9.33 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.49 / $21.88 / $42.66
| Professional | TC | $15.49 | $21.88 | $42.66 |