- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.63 / $10.06 / $13.58
| Facility | 26 | $8.63 | $10.06 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.13 / $31.20 / $45.04
| Professional | | $25.13 | $31.20 | $45.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.26 / $8.73 / $13.58
| Professional | 26 | $7.26 | $8.73 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.63 / $21.14 / $30.18
| Professional | TC | $17.63 | $21.14 | $30.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $25.94 / $35.36
| Professional | | $21.46 | $25.94 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.13 / $9.25 / $11.12
| Professional | 26 | $7.13 | $9.25 | $11.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $46.00 / $54.28
| Professional | | $29.48 | $46.00 | $54.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $11.43 / $13.49
| Professional | 26 | $8.34 | $11.43 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.26 / $34.57 / $40.79
| Professional | TC | $20.26 | $34.57 | $40.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.93 / $42.96 / $72.39
| Professional | | $29.93 | $42.96 | $72.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.35 / $11.47 / $27.48
| Professional | 26 | $8.35 | $11.47 | $27.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.68 / $31.19 / $54.60
| Professional | TC | $21.68 | $31.19 | $54.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.26 / $32.85 / $45.83
| Professional | | $25.26 | $32.85 | $45.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.06 / $8.32 / $11.26
| Professional | 26 | $6.06 | $8.32 | $11.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.38 / $24.64 / $34.28
| Professional | TC | $18.38 | $24.64 | $34.28 |