- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.26 / $13.20 / $16.16
| Facility | 26 | $12.26 | $13.20 | $16.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.59 / $35.02 / $49.21
| Professional | | $24.59 | $35.02 | $49.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.86 / $12.18 / $15.63
| Professional | 26 | $7.86 | $12.18 | $15.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.72 / $21.83 / $31.50
| Professional | TC | $16.72 | $21.83 | $31.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $8.86 / $8.86
| Professional | 26 | $8.86 | $8.86 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.07 / $41.12 / $45.69
| Professional | | $31.07 | $41.12 | $45.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.08 / $14.67 / $16.30
| Professional | 26 | $11.08 | $14.67 | $16.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.98 / $26.45 / $29.39
| Professional | TC | $19.98 | $26.45 | $29.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.83 / $42.35 / $58.92
| Professional | | $28.83 | $42.35 | $58.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.16 / $14.14 / $19.14
| Professional | 26 | $9.16 | $14.14 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.30 / $27.17 / $36.34
| Professional | TC | $19.30 | $27.17 | $36.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.26 / $20.38 / $20.38
| Professional | 26 | $18.26 | $20.38 | $20.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.00 / $35.46 / $57.17
| Professional | | $28.00 | $35.46 | $57.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.27 / $11.52 / $19.05
| Professional | 26 | $9.27 | $11.52 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.52 / $24.05 / $40.43
| Professional | TC | $18.52 | $24.05 | $40.43 |