- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.27 / $12.90 / $20.20
| Facility | 26 | $9.27 | $12.90 | $20.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.76 / $29.68 / $56.73
| Professional | | $25.76 | $29.68 | $56.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.39 / $9.39 / $20.59
| Professional | 26 | $8.39 | $9.39 | $20.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.28 / $20.05 / $39.15
| Professional | TC | $17.28 | $20.05 | $39.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.46 / $11.46 / $11.46
| Facility | 26 | $11.46 | $11.46 | $11.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.66 / $40.19 / $60.87
| Professional | | $28.66 | $40.19 | $60.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.59 / $13.30 / $20.24
| Professional | 26 | $9.59 | $13.30 | $20.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.98 / $25.59 / $41.69
| Professional | TC | $17.98 | $25.59 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.48 / $43.32 / $72.18
| Professional | | $27.48 | $43.32 | $72.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.92 / $13.97 / $22.75
| Professional | 26 | $8.92 | $13.97 | $22.75 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.88 / $29.05 / $50.26
| Professional | TC | $17.88 | $29.05 | $50.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.35 / $36.13 / $68.22
| Professional | | $24.35 | $36.13 | $68.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $12.48 / $25.63
| Professional | 26 | $7.90 | $12.48 | $25.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.23 / $24.60 / $45.10
| Professional | TC | $16.23 | $24.60 | $45.10 |