- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.09 / $17.89 / $23.05
| Facility | 26 | $14.09 | $17.89 | $23.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.36 / $46.04 / $73.26
| Professional | | $35.36 | $46.04 | $73.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.38 / $16.43 / $22.99
| Professional | 26 | $11.38 | $16.43 | $22.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.67 / $29.73 / $51.90
| Professional | TC | $23.67 | $29.73 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.83 / $12.83 / $14.39
| Professional | 26 | $12.83 | $12.83 | $14.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.23 / $56.81 / $68.73
| Professional | | $50.23 | $56.81 | $68.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.14 / $20.74 / $25.11
| Professional | 26 | $16.14 | $20.74 | $25.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.00 / $37.83 / $49.41
| Professional | TC | $33.00 | $37.83 | $49.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.51 / $13.21 / $16.22
| Professional | 26 | $12.51 | $13.21 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.61 / $41.86 / $76.06
| Professional | | $25.61 | $41.86 | $76.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.52 / $15.36 / $25.77
| Professional | 26 | $8.52 | $15.36 | $25.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.07 / $30.56 / $50.52
| Professional | TC | $17.07 | $30.56 | $50.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.95 / $44.88 / $70.26
| Professional | | $30.95 | $44.88 | $70.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.23 / $15.46 / $22.78
| Professional | 26 | $11.23 | $15.46 | $22.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.23 / $28.73 / $46.18
| Professional | TC | $20.23 | $28.73 | $46.18 |