- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.47 / $19.05
| Facility | 26 | $7.94 | $10.47 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $44.67 / $131.83
| Professional | | $25.12 | $44.67 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $10.96 / $46.77 / $70.79
| Professional | 25 | $10.96 | $46.77 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.24 / $10.72 / $33.11
| Professional | 26 | $7.24 | $10.72 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $26.92 / $48.98
| Professional | TC | $16.98 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $36.31 / $64.57
| Professional | | $24.55 | $36.31 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $10.47 / $20.42
| Professional | 26 | $7.59 | $10.47 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $25.70 / $47.86
| Professional | TC | $18.62 | $25.70 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1.95 / $10.47 / $18.20
| Facility | 26 | $1.95 | $10.47 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $43.65 / $81.28
| Professional | | $28.18 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $11.48 / $22.91
| Professional | 26 | $8.13 | $11.48 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $33.11 / $60.26
| Professional | TC | $20.89 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $38.02 / $67.61
| Professional | | $27.54 | $38.02 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $9.33 / $16.60
| Professional | 26 | $6.92 | $9.33 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $28.84 / $51.29
| Professional | TC | $20.89 | $28.84 | $51.29 |