- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.25 / $14.20 / $18.11
| Facility | 26 | $8.25 | $14.20 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $31.64 / $62.05
| Professional | | $25.80 | $31.64 | $62.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $8.25 / $18.11
| Professional | 26 | $7.33 | $8.25 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.29 / $23.10 / $43.94
| Professional | TC | $18.29 | $23.10 | $43.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.17 / $22.17 / $22.17
| Professional | | $22.17 | $22.17 | $22.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.42 / $8.00 / $15.12
| Professional | 26 | $6.42 | $8.00 | $15.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.00 / $41.00 / $41.00
| Professional | | $41.00 | $41.00 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $38.53 / $53.66
| Professional | | $23.61 | $38.53 | $53.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.17 / $12.82 / $16.57
| Professional | 26 | $7.17 | $12.82 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.18 / $26.93 / $37.57
| Professional | TC | $16.18 | $26.93 | $37.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.20 / $32.34 / $32.34
| Professional | | $7.20 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $33.02 / $54.00
| Professional | | $22.14 | $33.02 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.93 / $9.86 / $18.26
| Professional | 26 | $6.93 | $9.86 | $18.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.47 / $23.20 / $36.94
| Professional | TC | $15.47 | $23.20 | $36.94 |