- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.33 / $14.02 / $24.71
| Facility | 26 | $11.33 | $14.02 | $24.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.82 / $45.07 / $79.93
| Professional | | $36.82 | $45.07 | $79.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $10.97 / $20.59
| Professional | 26 | $9.41 | $10.97 | $20.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.20 / $32.26 / $57.10
| Professional | TC | $26.20 | $32.26 | $57.10 |
- 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
- $40.27 / $50.14 / $86.65
| Professional | | $40.27 | $50.14 | $86.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.77 / $14.60 / $23.14
| Professional | 26 | $10.77 | $14.60 | $23.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.19 / $37.06 / $64.12
| Professional | TC | $29.19 | $37.06 | $64.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.50 / $13.50 / $13.50
| Facility | 26 | $13.50 | $13.50 | $13.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.47 / $57.59 / $95.73
| Professional | | $39.47 | $57.59 | $95.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.32 / $15.34 / $25.80
| Professional | 26 | $10.32 | $15.34 | $25.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.16 / $43.13 / $69.79
| Professional | TC | $29.16 | $43.13 | $69.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.47 / $50.15 / $86.49
| Professional | | $39.47 | $50.15 | $86.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $13.80 / $24.00
| Professional | 26 | $10.36 | $13.80 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.05 / $36.00 / $65.77
| Professional | TC | $28.05 | $36.00 | $65.77 |