- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.47 / $8.86 / $29.35
| Facility | 26 | $8.47 | $8.86 | $29.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.95 / $29.92 / $45.90
| Professional | | $22.95 | $29.92 | $45.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.57 / $8.57 / $11.92
| Professional | 26 | $6.57 | $8.57 | $11.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.19 / $21.16 / $32.49
| Professional | TC | $16.19 | $21.16 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $7.75 / $7.78
| Professional | 26 | $7.41 | $7.75 | $7.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.28 / $36.33 / $60.69
| Professional | | $30.28 | $36.33 | $60.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.52 / $10.39 / $14.86
| Professional | 26 | $8.52 | $10.39 | $14.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.76 / $24.23 / $39.79
| Professional | TC | $21.76 | $24.23 | $39.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.74 / $6.74 / $7.25
| Professional | 26 | $6.74 | $6.74 | $7.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.87 / $34.38 / $62.01
| Professional | | $23.87 | $34.38 | $62.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.25 / $9.89 / $15.29
| Professional | 26 | $7.25 | $9.89 | $15.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.37 / $24.60 / $51.93
| Professional | TC | $17.37 | $24.60 | $51.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $30.59 / $59.40
| Professional | | $22.65 | $30.59 | $59.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.49 / $8.86 / $13.40
| Professional | 26 | $6.49 | $8.86 | $13.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.77 / $22.04 / $48.50
| Professional | TC | $15.77 | $22.04 | $48.50 |