- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.36 / $12.85 / $16.89
| Facility | 26 | $10.36 | $12.85 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.20 / $36.72 / $61.61
| Professional | | $29.20 | $36.72 | $61.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.42 / $12.16 / $16.89
| Professional | 26 | $8.42 | $12.16 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.78 / $25.53 / $42.63
| Professional | TC | $20.78 | $25.53 | $42.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.03 / $11.03 / $11.03
| Professional | 26 | $11.03 | $11.03 | $11.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.56 / $44.52 / $57.75
| Professional | | $39.56 | $44.52 | $57.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.84 / $15.65 / $22.10
| Professional | 26 | $11.84 | $15.65 | $22.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.73 / $31.70 / $44.35
| Professional | TC | $27.73 | $31.70 | $44.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.16 / $9.88 / $24.77
| Professional | 26 | $9.16 | $9.88 | $24.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.29 / $36.06 / $60.34
| Professional | | $20.29 | $36.06 | $60.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.24 / $11.65 / $19.05
| Professional | 26 | $6.24 | $11.65 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.05 / $25.34 / $41.88
| Professional | TC | $14.05 | $25.34 | $41.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.31 / $36.08 / $55.44
| Professional | | $25.31 | $36.08 | $55.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $11.63 / $18.03
| Professional | 26 | $8.71 | $11.63 | $18.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.72 / $23.46 / $35.79
| Professional | TC | $15.72 | $23.46 | $35.79 |