- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $18.62 / $48.98
| Facility | 26 | $10.23 | $18.62 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $36.31 / $87.10
| Professional | | $16.98 | $36.31 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $17.38 / $50.12
| Professional | 26 | $8.71 | $17.38 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.00 / $22.91 / $50.12
| Professional | TC | $10.00 | $22.91 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $8.51 / $8.51
| Facility | 26 | $8.51 | $8.51 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $29.51 / $70.79
| Professional | | $13.18 | $29.51 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $12.02 / $26.30
| Professional | 26 | $6.31 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.76 / $16.98 / $45.71
| Professional | TC | $6.76 | $16.98 | $45.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.72 / $19.50 / $47.86
| Facility | 26 | $3.72 | $19.50 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $36.31 / $102.33
| Professional | | $17.38 | $36.31 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $14.45 / $37.15
| Professional | 26 | $7.94 | $14.45 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.00 / $22.91 / $67.61
| Professional | TC | $10.00 | $22.91 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $38.90 / $79.43
| Professional | | $17.78 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $14.79 / $29.51
| Professional | 26 | $7.41 | $14.79 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.23 / $24.55 / $48.98
| Professional | TC | $10.23 | $24.55 | $48.98 |