- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.30 / $16.45 / $29.00
| Facility | 26 | $13.30 | $16.45 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.24 / $42.41 / $77.45
| Professional | | $36.24 | $42.41 | $77.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.50 / $13.39 / $28.64
| Professional | 26 | $11.50 | $13.39 | $28.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.67 / $28.75 / $54.22
| Professional | TC | $23.67 | $28.75 | $54.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.35 / $14.35 / $14.35
| Facility | 26 | $14.35 | $14.35 | $14.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.52 / $49.28 / $81.92
| Professional | | $39.52 | $49.28 | $81.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.26 / $17.80 / $27.36
| Professional | 26 | $13.26 | $17.80 | $27.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.90 / $33.97 / $55.25
| Professional | TC | $25.90 | $33.97 | $55.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.80 / $15.80 / $15.80
| Facility | 26 | $15.80 | $15.80 | $15.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.17 / $56.85 / $93.76
| Professional | | $38.17 | $56.85 | $93.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.08 / $19.10 / $31.63
| Professional | 26 | $12.08 | $19.10 | $31.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.60 / $37.13 / $62.65
| Professional | TC | $25.60 | $37.13 | $62.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.40 / $47.25 / $82.99
| Professional | | $38.40 | $47.25 | $82.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.84 / $16.68 / $29.48
| Professional | 26 | $12.84 | $16.68 | $29.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.08 / $32.20 / $54.78
| Professional | TC | $25.08 | $32.20 | $54.78 |