- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.73 / $16.73 / $16.73
| Facility | 26 | $16.73 | $16.73 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $37.17 / $54.08
| Professional | | $30.90 | $37.17 | $54.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.64 / $11.82 / $16.73
| Professional | 26 | $9.64 | $11.82 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $25.76 / $37.35
| Professional | TC | $21.26 | $25.76 | $37.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.06 / $42.20 / $44.09
| Professional | | $32.06 | $42.20 | $44.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.49 / $10.49 / $11.41
| Professional | 26 | $10.49 | $10.49 | $11.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.13 / $39.90 / $47.09
| Professional | | $29.13 | $39.90 | $47.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.67 / $13.25 / $15.64
| Professional | 26 | $9.67 | $13.25 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $26.66 / $31.46
| Professional | TC | $19.46 | $26.66 | $31.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $44.60 / $95.70
| Professional | | $29.74 | $44.60 | $95.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.05 / $16.72 / $30.51
| Professional | 26 | $10.05 | $16.72 | $30.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.89 / $29.00 / $71.31
| Professional | TC | $21.89 | $29.00 | $71.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.92 / $38.45 / $51.89
| Professional | | $29.92 | $38.45 | $51.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.29 / $13.17 / $18.73
| Professional | 26 | $10.29 | $13.17 | $18.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.32 / $25.66 / $34.21
| Professional | TC | $19.32 | $25.66 | $34.21 |