- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.00 / $11.27 / $14.65
| Facility | 26 | $9.00 | $11.27 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.92 / $32.77 / $52.63
| Professional | | $24.92 | $32.77 | $52.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.29 / $10.24 / $15.58
| Professional | 26 | $7.29 | $10.24 | $15.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.57 / $22.62 / $39.15
| Professional | TC | $17.57 | $22.62 | $39.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $20.32 / $20.32
| Professional | | $20.32 | $20.32 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.40 / $8.13 / $9.56
| Professional | 26 | $6.40 | $8.13 | $9.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.75 / $40.11 / $50.17
| Professional | | $35.75 | $40.11 | $50.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.27 / $13.14 / $15.64
| Professional | 26 | $10.27 | $13.14 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.68 / $28.29 / $37.40
| Professional | TC | $24.68 | $28.29 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $8.58 / $17.07
| Professional | 26 | $7.94 | $8.58 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $29.89 / $54.51
| Professional | | $18.32 | $29.89 | $54.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.41 / $9.64 / $16.27
| Professional | 26 | $5.41 | $9.64 | $16.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.91 / $20.64 / $38.24
| Professional | TC | $12.91 | $20.64 | $38.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $31.04 / $46.56
| Professional | | $21.26 | $31.04 | $46.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.04 / $9.67 / $14.70
| Professional | 26 | $7.04 | $9.67 | $14.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.06 / $20.64 / $31.92
| Professional | TC | $14.06 | $20.64 | $31.92 |