- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $10.21 / $22.41
| Facility | 26 | $9.30 | $10.21 | $22.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $41.82 / $75.04
| Professional | | $31.38 | $41.82 | $75.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $10.47 / $22.41
| Professional | 26 | $9.30 | $10.47 | $22.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.08 / $28.17 / $42.58
| Professional | TC | $22.08 | $28.17 | $42.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.40 / $26.85 / $30.89
| Professional | | $26.40 | $26.85 | $30.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.91 / $9.89 / $24.73
| Professional | 26 | $7.91 | $9.89 | $24.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.95 / $23.95 / $26.51
| Professional | TC | $23.95 | $23.95 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.00 / $59.00 / $59.00
| Professional | | $59.00 | $59.00 | $59.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.65 / $49.07 / $69.94
| Professional | | $30.65 | $49.07 | $69.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.19 / $16.57 / $21.52
| Professional | 26 | $9.19 | $16.57 | $21.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.57 / $32.86 / $49.11
| Professional | TC | $20.57 | $32.86 | $49.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.01 / $32.34 / $32.34
| Professional | | $9.01 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.86 / $40.98 / $74.34
| Professional | | $28.86 | $40.98 | $74.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.09 / $13.10 / $22.76
| Professional | 26 | $9.09 | $13.10 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.26 / $28.15 / $51.86
| Professional | TC | $20.26 | $28.15 | $51.86 |