- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.03 / $13.83 / $17.97
| Facility | 26 | $11.03 | $13.83 | $17.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.27 / $45.55 / $73.12
| Professional | | $34.27 | $45.55 | $73.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $12.56 / $17.48
| Professional | 26 | $8.84 | $12.56 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.28 / $32.11 / $51.90
| Professional | TC | $25.28 | $32.11 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.74 / $11.74 / $11.74
| Professional | 26 | $11.74 | $11.74 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.31 / $51.84 / $71.09
| Professional | | $46.31 | $51.84 | $71.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.71 / $16.16 / $20.42
| Professional | 26 | $12.71 | $16.16 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.70 / $38.53 / $51.93
| Professional | TC | $33.70 | $38.53 | $51.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.76 / $9.76 / $10.54
| Professional | 26 | $9.76 | $9.76 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.73 / $42.15 / $72.38
| Professional | | $23.73 | $42.15 | $72.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.65 / $12.19 / $20.00
| Professional | 26 | $6.65 | $12.19 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.07 / $30.82 / $52.84
| Professional | TC | $17.07 | $30.82 | $52.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.60 / $43.07 / $70.34
| Professional | | $29.60 | $43.07 | $70.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.94 / $11.55 / $19.70
| Professional | 26 | $8.94 | $11.55 | $19.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.66 / $30.23 / $54.16
| Professional | TC | $20.66 | $30.23 | $54.16 |