- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.07 / $15.17 / $19.72
| Facility | 26 | $12.07 | $15.17 | $19.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $46.90 / $75.30
| Professional | | $37.36 | $46.90 | $75.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $13.74 / $19.22
| Professional | 26 | $8.84 | $13.74 | $19.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.53 / $33.72 / $57.10
| Professional | TC | $27.53 | $33.72 | $57.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.97 / $11.14 / $11.14
| Professional | 26 | $10.97 | $11.14 | $11.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.87 / $56.97 / $72.47
| Professional | | $50.87 | $56.97 | $72.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.81 / $17.36 / $20.38
| Professional | 26 | $13.81 | $17.36 | $20.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.07 / $42.25 / $60.78
| Professional | TC | $37.07 | $42.25 | $60.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.69 / $11.23 / $26.55
| Professional | 26 | $10.69 | $11.23 | $26.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.08 / $44.87 / $76.86
| Professional | | $26.08 | $44.87 | $76.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.29 / $12.34 / $21.87
| Professional | 26 | $7.29 | $12.34 | $21.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.78 / $33.89 / $56.49
| Professional | TC | $18.78 | $33.89 | $56.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.37 / $44.61 / $68.56
| Professional | | $31.37 | $44.61 | $68.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.24 / $12.74 / $18.95
| Professional | 26 | $9.24 | $12.74 | $18.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $31.00 / $54.89
| Professional | TC | $21.26 | $31.00 | $54.89 |