- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.45 / $3.72 / $3.72
| Facility | 26 | $2.45 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $18.62 / $36.31
| Professional | | $12.88 | $18.62 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.00 / $3.02 / $8.13
| Professional | 26 | $2.00 | $3.02 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $12.88 / $23.99
| Professional | TC | $10.96 | $12.88 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $14.45 / $16.22
| Professional | | $11.75 | $14.45 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $2.69 / $3.55
| Professional | 26 | $2.29 | $2.69 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $31.62 / $37.15
| Professional | | $15.85 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.95 / $5.89 / $7.08
| Professional | 26 | $2.95 | $5.89 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $25.70 / $30.20
| Professional | TC | $12.88 | $25.70 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $27.54 / $54.95
| Professional | | $15.85 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $6.61 / $10.72
| Professional | 26 | $3.02 | $6.61 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $21.38 / $44.67
| Professional | TC | $12.88 | $21.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $21.38 / $32.36
| Professional | | $15.85 | $21.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.31 / $4.79 / $7.08
| Professional | 26 | $3.31 | $4.79 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.59 / $16.98 / $25.12
| Professional | TC | $12.59 | $16.98 | $25.12 |