- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.03 / $10.35 / $18.42
| Facility | 26 | $8.03 | $10.35 | $18.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $31.10 / $61.68
| Professional | | $26.78 | $31.10 | $61.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.93 / $8.02 / $17.11
| Professional | 26 | $6.93 | $8.02 | $17.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.46 / $22.44 / $43.78
| Professional | TC | $19.46 | $22.44 | $43.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.99 / $37.33 / $60.32
| Professional | | $27.99 | $37.33 | $60.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.01 / $11.06 / $16.56
| Professional | 26 | $8.01 | $11.06 | $16.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.61 / $26.84 / $44.89
| Professional | TC | $20.61 | $26.84 | $44.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Facility | 26 | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.58 / $40.21 / $70.31
| Professional | | $27.58 | $40.21 | $70.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.38 / $11.78 / $19.27
| Professional | 26 | $7.38 | $11.78 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.48 / $28.39 / $50.89
| Professional | TC | $19.48 | $28.39 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.27 / $35.61 / $61.20
| Professional | | $28.27 | $35.61 | $61.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.07 / $9.92 / $17.87
| Professional | 26 | $8.07 | $9.92 | $17.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.57 / $25.07 / $44.20
| Professional | TC | $19.57 | $25.07 | $44.20 |