- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.94 / $10.94 / $20.81
| Facility | 26 | $10.94 | $10.94 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.03 / $28.34 / $54.44
| Professional | | $28.03 | $28.34 | $54.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.53 / $7.63 / $11.95
| Professional | 26 | $7.53 | $7.63 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.39 / $20.81 / $31.62
| Professional | TC | $20.39 | $20.81 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.38 / $32.64 / $57.86
| Professional | | $23.38 | $32.64 | $57.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $9.08 / $15.08
| Professional | 26 | $6.03 | $9.08 | $15.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.18 / $24.08 / $42.59
| Professional | TC | $16.18 | $24.08 | $42.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.58 / $32.88 / $70.33
| Professional | | $25.58 | $32.88 | $70.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.83 / $8.66 / $19.73
| Professional | 26 | $6.83 | $8.66 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.28 / $27.10 / $50.27
| Professional | TC | $18.28 | $27.10 | $50.27 |