- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.99 / $9.59 / $12.98
| Facility | 26 | $7.99 | $9.59 | $12.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.89 / $26.02 / $40.61
| Professional | | $19.89 | $26.02 | $40.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.29 / $9.08 / $13.54
| Professional | 26 | $6.29 | $9.08 | $13.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.60 / $17.00 / $28.72
| Professional | TC | $13.60 | $17.00 | $28.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $8.46 / $17.55
| Professional | 26 | $7.08 | $8.46 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.85 / $31.48 / $39.02
| Professional | | $27.85 | $31.48 | $39.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.10 / $11.63 / $13.87
| Professional | 26 | $9.10 | $11.63 | $13.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.70 / $21.22 / $27.92
| Professional | TC | $18.70 | $21.22 | $27.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.03 / $7.03 / $7.59
| Professional | 26 | $7.03 | $7.03 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.29 / $23.40 / $42.62
| Professional | | $14.29 | $23.40 | $42.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $4.79 / $8.64 / $14.41
| Professional | 26 | $4.79 | $8.64 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.50 / $17.14 / $28.19
| Professional | TC | $9.50 | $17.14 | $28.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $24.85 / $38.86
| Professional | | $17.23 | $24.85 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.38 / $8.66 / $12.69
| Professional | 26 | $6.38 | $8.66 | $12.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.42 / $15.89 / $24.85
| Professional | TC | $11.42 | $15.89 | $24.85 |