- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.49 / $36.31
| Facility | 26 | $7.94 | $13.49 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $38.02 / $128.82
| Professional | | $25.70 | $38.02 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $12.59 / $32.36
| Professional | 26 | $7.59 | $12.59 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $25.12 / $57.54
| Professional | TC | $18.20 | $25.12 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Facility | 26 | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $38.90 / $70.79
| Professional | | $27.54 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $12.59 / $21.88
| Professional | 26 | $9.12 | $12.59 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $26.92 / $50.12
| Professional | TC | $18.20 | $26.92 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $12.30 / $29.51
| Facility | 26 | $2.29 | $12.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $87.10
| Professional | | $26.30 | $43.65 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.49 / $26.30
| Professional | 26 | $7.94 | $13.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $30.90 / $64.57
| Professional | TC | $18.20 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $34.67 / $66.07
| Professional | | $26.30 | $34.67 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $10.72 / $20.42
| Professional | 26 | $8.13 | $10.72 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $24.55 / $45.71
| Professional | TC | $18.20 | $24.55 | $45.71 |