- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.69 / $11.38 / $11.38
| Facility | 26 | $9.69 | $11.38 | $11.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.85 / $26.77 / $32.81
| Professional | | $25.85 | $26.77 | $32.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $7.40 / $8.56
| Professional | 26 | $7.33 | $7.40 | $8.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.53 / $19.37 / $24.25
| Professional | TC | $18.53 | $19.37 | $24.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $30.96 / $57.89
| Professional | | $23.61 | $30.96 | $57.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.25 / $8.86 / $15.69
| Professional | 26 | $6.25 | $8.86 | $15.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.77 / $22.23 / $42.00
| Professional | TC | $12.77 | $22.23 | $42.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.22 / $36.22 / $36.22
| Professional | | $36.22 | $36.22 | $36.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.24 / $15.24 / $16.22
| Professional | 26 | $15.24 | $15.24 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $61.04 / $72.44 / $72.45
| Professional | 50 | $61.04 | $72.44 | $72.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $30.37 / $69.15
| Professional | | $22.92 | $30.37 | $69.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.34 / $9.86 / $19.25
| Professional | 26 | $6.34 | $9.86 | $19.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.37 / $22.06 / $50.22
| Professional | TC | $16.37 | $22.06 | $50.22 |