- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $13.29 / $20.03
| Facility | 26 | $10.36 | $13.29 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.15 / $41.33 / $83.22
| Professional | | $34.15 | $41.33 | $83.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $10.99 / $25.05
| Professional | 26 | $9.41 | $10.99 | $25.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.67 / $28.18 / $53.79
| Professional | TC | $23.67 | $28.18 | $53.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.46 / $11.46 / $11.46
| Facility | 26 | $11.46 | $11.46 | $11.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.49 / $44.43 / $75.55
| Professional | | $35.49 | $44.43 | $75.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.35 / $14.56 / $21.58
| Professional | 26 | $10.35 | $14.56 | $21.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.79 / $32.47 / $54.36
| Professional | TC | $24.79 | $32.47 | $54.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.36 / $12.36 / $12.36
| Facility | 26 | $12.36 | $12.36 | $12.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.45 / $49.84 / $84.04
| Professional | | $32.45 | $49.84 | $84.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.72 / $15.02 / $24.25
| Professional | 26 | $9.72 | $15.02 | $24.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.74 / $35.63 / $60.63
| Professional | TC | $24.74 | $35.63 | $60.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.72 / $42.90 / $74.83
| Professional | | $34.72 | $42.90 | $74.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.28 / $13.30 / $25.05
| Professional | 26 | $10.28 | $13.30 | $25.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.85 / $30.48 / $51.43
| Professional | TC | $23.85 | $30.48 | $51.43 |