- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.59 / $14.46 / $18.72
| Facility | 26 | $13.59 | $14.46 | $18.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $45.78 / $75.30
| Professional | | $34.04 | $45.78 | $75.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $13.78 / $20.61
| Professional | 26 | $9.41 | $13.78 | $20.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.47 / $31.99 / $61.97
| Professional | TC | $24.47 | $31.99 | $61.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.98 / $19.37 / $21.62
| Professional | 26 | $18.98 | $19.37 | $21.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.94 / $50.22 / $55.80
| Professional | | $37.94 | $50.22 | $55.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.23 / $14.86 / $16.51
| Professional | 26 | $11.23 | $14.86 | $16.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.72 / $35.36 / $39.29
| Professional | TC | $26.72 | $35.36 | $39.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.17 / $59.83 / $80.86
| Professional | | $40.17 | $59.83 | $80.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.70 / $15.02 / $23.04
| Professional | 26 | $10.70 | $15.02 | $23.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.43 / $41.14 / $53.46
| Professional | TC | $29.43 | $41.14 | $53.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.40 / $22.28 / $24.86
| Professional | 26 | $21.40 | $22.28 | $24.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.75 / $55.18 / $77.91
| Professional | | $39.75 | $55.18 | $77.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.61 / $13.80 / $22.74
| Professional | 26 | $10.61 | $13.80 | $22.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.87 / $32.76 / $55.87
| Professional | TC | $27.87 | $32.76 | $55.87 |