- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $8.71 / $15.85
| Facility | 26 | $8.71 | $8.71 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $38.90 / $70.79
| Professional | | $28.18 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.23 / $22.91
| Professional | 26 | $7.94 | $10.23 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $25.70 / $45.71
| Professional | TC | $19.05 | $25.70 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $27.54 / $48.98
| Professional | | $22.39 | $27.54 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $11.22 / $22.91
| Professional | 26 | $7.41 | $11.22 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $19.50 / $23.99
| Professional | TC | $19.50 | $19.50 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Professional | | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $44.67 / $69.18
| Professional | | $23.99 | $44.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $15.49 / $22.39
| Professional | 26 | $8.13 | $15.49 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $30.20 / $45.71
| Professional | TC | $16.60 | $30.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $32.36 / $33.11
| Professional | | $18.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $36.31 / $69.18
| Professional | | $26.30 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $11.75 / $22.39
| Professional | 26 | $9.12 | $11.75 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $23.99 / $46.77
| Professional | TC | $17.38 | $23.99 | $46.77 |