- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $19.05 / $25.12
| Facility | 26 | $16.98 | $19.05 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $39.81 / $63.10
| Professional | | $18.20 | $39.81 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $16.60 / $38.02
| Professional | 26 | $7.24 | $16.60 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $25.12 / $36.31
| Professional | TC | $10.96 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $11.75 / $20.89
| Professional | 26 | $11.48 | $11.75 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $52.48 / $60.26
| Professional | | $30.20 | $52.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $19.50 / $23.44
| Professional | 26 | $13.49 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $33.11 / $35.48
| Professional | TC | $16.98 | $33.11 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $15.85 / $15.85
| Professional | 26 | $14.45 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $33.11 / $70.79
| Professional | | $14.13 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $13.18 / $27.54
| Professional | 26 | $7.41 | $13.18 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.33 / $21.38 / $42.66
| Professional | TC | $9.33 | $21.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $38.02 / $56.23
| Professional | | $16.22 | $38.02 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $14.45 / $20.89
| Professional | 26 | $6.92 | $14.45 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.33 / $23.99 / $35.48
| Professional | TC | $9.33 | $23.99 | $35.48 |