- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $12.30 / $17.38
| Facility | 26 | $9.77 | $12.30 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $38.90 / $85.11
| Professional | | $32.36 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.00 / $25.12
| Professional | 26 | $7.94 | $10.00 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $28.18 / $58.88
| Professional | TC | $22.91 | $28.18 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $8.71 / $14.45
| Professional | 26 | $8.51 | $8.71 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Professional | TC | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $38.90 / $64.57
| Professional | | $35.48 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $14.45 / $22.91
| Professional | 26 | $11.22 | $14.45 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $24.55 / $45.71
| Professional | TC | $23.99 | $24.55 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $50.12 / $87.10
| Professional | | $33.11 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $14.13 / $23.99
| Professional | 26 | $8.91 | $14.13 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $35.48 / $64.57
| Professional | TC | $24.55 | $35.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $66.07
| Professional | | $33.88 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $11.48 / $19.50
| Professional | 26 | $9.77 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $28.84 / $45.71
| Professional | TC | $23.44 | $28.84 | $45.71 |