- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.15 / $15.75 / $20.09
| Facility | 26 | $9.15 | $15.75 | $20.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.83 / $34.04 / $61.54
| Professional | | $25.83 | $34.04 | $61.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.35 / $9.98 / $20.09
| Professional | 26 | $8.35 | $9.98 | $20.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.48 / $24.48 / $41.46
| Professional | TC | $17.48 | $24.48 | $41.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $62.81 / $62.81
| Professional | | $19.14 | $62.81 | $62.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $8.86 / $17.47
| Professional | 26 | $8.86 | $8.86 | $17.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.00 / $49.00 / $49.00
| Professional | | $49.00 | $49.00 | $49.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.72 / $41.98 / $56.90
| Professional | | $24.72 | $41.98 | $56.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.00 / $14.79 / $19.69
| Professional | 26 | $8.00 | $14.79 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.30 / $26.44 / $37.57
| Professional | TC | $16.30 | $26.44 | $37.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.98 / $32.34 / $32.34
| Professional | | $7.98 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.48 / $34.02 / $62.82
| Professional | | $23.48 | $34.02 | $62.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.98 / $11.18 / $19.69
| Professional | 26 | $7.98 | $11.18 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.50 / $22.05 / $40.72
| Professional | TC | $15.50 | $22.05 | $40.72 |