- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.54 / $8.86 / $14.14
| Facility | 26 | $7.54 | $8.86 | $14.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.23 / $32.90 / $115.23
| Professional | | $25.23 | $32.90 | $115.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.67 / $8.57 / $33.61
| Professional | 26 | $6.67 | $8.57 | $33.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.80 / $22.57 / $37.27
| Professional | TC | $17.80 | $22.57 | $37.27 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.85 / $7.85 / $7.85
| Facility | 26 | $7.85 | $7.85 | $7.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.30 / $39.67 / $74.87
| Professional | | $25.30 | $39.67 | $74.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.21 / $10.51 / $17.81
| Professional | 26 | $7.21 | $10.51 | $17.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.52 / $29.16 / $57.98
| Professional | TC | $18.52 | $29.16 | $57.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.11 / $8.11 / $8.11
| Facility | 26 | $8.11 | $8.11 | $8.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.68 / $42.24 / $73.42
| Professional | | $26.68 | $42.24 | $73.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.52 / $10.74 / $18.47
| Professional | 26 | $7.52 | $10.74 | $18.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.55 / $30.98 / $54.47
| Professional | TC | $19.55 | $30.98 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.10 / $39.65 / $64.88
| Professional | | $26.10 | $39.65 | $64.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.28 / $9.81 / $15.61
| Professional | 26 | $7.28 | $9.81 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.26 / $27.44 / $49.38
| Professional | TC | $18.26 | $27.44 | $49.38 |