- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $15.14 / $39.81
| Facility | 26 | $8.32 | $15.14 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $30.90 / $85.11
| Professional | | $22.91 | $30.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $9.77 / $28.18
| Professional | 26 | $7.94 | $9.77 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $20.89 / $46.77
| Professional | TC | $15.14 | $20.89 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Facility | 26 | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $38.90 / $85.11
| Professional | | $26.30 | $38.90 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $13.49 / $23.44
| Professional | 26 | $9.55 | $13.49 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $25.12 / $53.70
| Professional | TC | $16.22 | $25.12 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $12.30 / $29.51
| Facility | 26 | $2.29 | $12.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $43.65 / $85.11
| Professional | | $24.55 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.80 / $26.92
| Professional | 26 | $7.94 | $13.80 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $29.51 / $60.26
| Professional | TC | $16.22 | $29.51 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $33.88 / $66.07
| Professional | | $22.39 | $33.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $10.96 / $20.89
| Professional | 26 | $7.41 | $10.96 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.79 / $22.39 / $44.67
| Professional | TC | $14.79 | $22.39 | $44.67 |