- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.02 / $11.18 / $19.67
| Facility | 26 | $9.02 | $11.18 | $19.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.87 / $34.22 / $67.98
| Professional | | $27.87 | $34.22 | $67.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.11 / $9.58 / $20.98
| Professional | 26 | $8.11 | $9.58 | $20.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.68 / $23.23 / $43.59
| Professional | TC | $19.68 | $23.23 | $43.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Facility | 26 | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.35 / $37.71 / $64.18
| Professional | | $30.35 | $37.71 | $64.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.20 / $12.82 / $18.88
| Professional | 26 | $9.20 | $12.82 | $18.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.18 / $27.25 / $44.97
| Professional | TC | $20.18 | $27.25 | $44.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $43.24 / $71.36
| Professional | | $29.74 | $43.24 | $71.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.55 / $13.54 / $22.00
| Professional | 26 | $8.55 | $13.54 | $22.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.66 / $30.10 / $50.98
| Professional | TC | $20.66 | $30.10 | $50.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.88 / $37.34 / $63.08
| Professional | | $29.88 | $37.34 | $63.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.36 / $11.56 / $20.96
| Professional | 26 | $9.36 | $11.56 | $20.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.26 / $25.45 / $44.44
| Professional | TC | $20.26 | $25.45 | $44.44 |