- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.33 / $15.79 / $25.36
| Facility | 26 | $12.33 | $15.79 | $25.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.31 / $42.35 / $98.20
| Professional | | $28.31 | $42.35 | $98.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.28 / $13.47 / $33.88
| Professional | 26 | $11.28 | $13.47 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.12 / $29.55 / $57.40
| Professional | TC | $24.12 | $29.55 | $57.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.61 / $14.61 / $14.61
| Facility | 26 | $14.61 | $14.61 | $14.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.63 / $47.41 / $78.89
| Professional | | $36.63 | $47.41 | $78.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.37 / $17.39 / $25.70
| Professional | 26 | $12.37 | $17.39 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.67 / $33.17 / $53.30
| Professional | TC | $24.67 | $33.17 | $53.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.65 / $14.65 / $14.65
| Facility | 26 | $14.65 | $14.65 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.96 / $53.29 / $90.19
| Professional | | $35.96 | $53.29 | $90.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.56 / $18.30 / $29.80
| Professional | 26 | $11.56 | $18.30 | $29.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.12 / $35.19 / $60.53
| Professional | TC | $24.12 | $35.19 | $60.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.72 / $45.65 / $78.19
| Professional | | $36.72 | $45.65 | $78.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.60 / $15.74 / $30.82
| Professional | 26 | $12.60 | $15.74 | $30.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.87 / $30.16 / $52.36
| Professional | TC | $23.87 | $30.16 | $52.36 |