- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $13.18 / $33.88
| Facility | 26 | $7.08 | $13.18 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $33.88 / $95.50
| Professional | | $23.99 | $33.88 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $9.33 / $24.55
| Professional | 26 | $6.03 | $9.33 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $23.99 / $50.12
| Professional | TC | $16.98 | $23.99 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $9.33 / $9.33
| Facility | 26 | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $35.48 / $66.07
| Professional | | $26.30 | $35.48 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.96 / $18.62
| Professional | 26 | $7.08 | $10.96 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $25.12 / $48.98
| Professional | TC | $18.20 | $25.12 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.04 / $10.96 / $25.12
| Facility | 26 | $2.04 | $10.96 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $40.74 / $83.18
| Professional | | $24.55 | $40.74 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $11.75 / $22.91
| Professional | 26 | $6.76 | $11.75 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $29.51 / $64.57
| Professional | TC | $18.20 | $29.51 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $32.36 / $63.10
| Professional | | $24.55 | $32.36 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.12 / $17.38
| Professional | 26 | $7.08 | $9.12 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $23.44 / $45.71
| Professional | TC | $17.78 | $23.44 | $45.71 |