- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.56 / $11.08 / $13.86
| Facility | 26 | $6.56 | $11.08 | $13.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.92 / $29.66 / $110.98
| Professional | | $24.92 | $29.66 | $110.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.64 / $24.46
| Professional | 26 | $7.33 | $8.64 | $24.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.76 / $20.92 / $51.18
| Professional | TC | $16.76 | $20.92 | $51.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.26 / $21.48 / $36.83
| Professional | | $6.26 | $21.48 | $36.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $35.86 / $49.42
| Professional | | $26.52 | $35.86 | $49.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.65 / $10.90 / $15.32
| Professional | 26 | $7.65 | $10.90 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.38 / $23.89 / $34.29
| Professional | TC | $18.38 | $23.89 | $34.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $32.34 / $36.79
| Professional | | $10.74 | $32.34 | $36.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.99 / $43.71 / $70.27
| Professional | | $26.99 | $43.71 | $70.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.65 / $11.44 / $15.32
| Professional | 26 | $7.65 | $11.44 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.14 / $25.73 / $34.10
| Professional | TC | $18.14 | $25.73 | $34.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.69 / $31.04 / $71.11
| Professional | | $26.69 | $31.04 | $71.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.36 / $9.38 / $21.59
| Professional | 26 | $8.36 | $9.38 | $21.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.03 / $21.66 / $47.39
| Professional | TC | $18.03 | $21.66 | $47.39 |