- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.64 / $10.14 / $11.05
| Professional | 26 | $9.64 | $10.14 | $11.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.98 / $26.66 / $28.53
| Professional | TC | $23.98 | $26.66 | $28.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $15.02 / $49.89
| Professional | 26 | $8.83 | $15.02 | $49.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.24 / $33.69 / $124.74
| Professional | TC | $21.24 | $33.69 | $124.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.97 / $13.86 / $26.13
| Professional | 26 | $7.97 | $13.86 | $26.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.46 / $32.14 / $55.58
| Professional | TC | $18.46 | $32.14 | $55.58 |