- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.76 / $12.85 / $22.64
| Facility | 26 | $9.76 | $12.85 | $22.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.50 / $36.72 / $79.86
| Professional | | $29.50 | $36.72 | $79.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.80 / $10.75 / $24.56
| Professional | 26 | $8.80 | $10.75 | $24.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.47 / $25.53 / $46.22
| Professional | TC | $20.47 | $25.53 | $46.22 |
- 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
- $31.60 / $39.51 / $68.02
| Professional | | $31.60 | $39.51 | $68.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.74 / $13.89 / $20.30
| Professional | 26 | $9.74 | $13.89 | $20.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.93 / $27.68 / $46.68
| Professional | TC | $21.93 | $27.68 | $46.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.56 / $11.56 / $11.56
| Facility | 26 | $11.56 | $11.56 | $11.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.31 / $46.47 / $75.93
| Professional | | $30.31 | $46.47 | $75.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.61 / $14.97 / $24.19
| Professional | 26 | $9.61 | $14.97 | $24.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.61 / $31.84 / $52.54
| Professional | TC | $21.61 | $31.84 | $52.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $38.14 / $68.17
| Professional | | $31.78 | $38.14 | $68.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.08 / $12.66 / $21.82
| Professional | 26 | $10.08 | $12.66 | $21.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.56 / $26.72 / $45.90
| Professional | TC | $21.56 | $26.72 | $45.90 |