- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.40 / $9.77 / $12.69
| Facility | 26 | $9.40 | $9.77 | $12.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.51 / $31.41 / $33.47
| Professional | | $26.51 | $31.41 | $33.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.24 / $9.40 / $9.98
| Professional | 26 | $8.24 | $9.40 | $9.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.27 / $22.01 / $23.48
| Professional | TC | $18.27 | $22.01 | $23.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.38 / $33.07 / $57.33
| Professional | | $23.38 | $33.07 | $57.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.97 / $10.54 / $17.51
| Professional | 26 | $6.97 | $10.54 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.47 / $23.68 / $39.63
| Professional | TC | $15.47 | $23.68 | $39.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.61 / $32.32 / $69.91
| Professional | | $24.61 | $32.32 | $69.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.54 / $10.65 / $23.28
| Professional | 26 | $7.54 | $10.65 | $23.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.19 / $27.10 / $47.82
| Professional | TC | $17.19 | $27.10 | $47.82 |