- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.69 / $12.56 / $15.80
| Facility | 26 | $9.69 | $12.56 | $15.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.55 / $35.04 / $55.96
| Professional | | $27.55 | $35.04 | $55.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.86 / $11.40 / $16.09
| Professional | 26 | $7.86 | $11.40 | $16.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.57 / $23.74 / $41.46
| Professional | TC | $19.57 | $23.74 | $41.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.77 / $9.86 / $17.38
| Professional | 26 | $8.77 | $9.86 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.40 / $43.13 / $53.64
| Professional | | $38.40 | $43.13 | $53.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $14.19 / $18.22
| Professional | 26 | $11.16 | $14.19 | $18.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.48 / $30.36 / $39.29
| Professional | TC | $26.48 | $30.36 | $39.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.56 / $9.25 / $16.07
| Professional | 26 | $8.56 | $9.25 | $16.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $32.22 / $58.58
| Professional | | $19.51 | $32.22 | $58.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.84 / $10.61 / $17.86
| Professional | 26 | $5.84 | $10.61 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.67 / $24.66 / $41.03
| Professional | TC | $13.67 | $24.66 | $41.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $34.40 / $53.34
| Professional | | $24.26 | $34.40 | $53.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.10 / $10.78 / $17.36
| Professional | 26 | $8.10 | $10.78 | $17.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.77 / $22.73 / $36.86
| Professional | TC | $14.77 | $22.73 | $36.86 |