- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $11.22 / $28.18
| Facility | 26 | $6.92 | $11.22 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $26.30 / $64.57
| Professional | | $18.20 | $26.30 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $10.00 / $25.70
| Professional | 26 | $6.03 | $10.00 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.02 / $16.98 / $37.15
| Professional | TC | $12.02 | $16.98 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $8.13 / $8.13
| Facility | 26 | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $27.54 / $51.29
| Professional | | $20.42 | $27.54 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $9.77 / $16.98
| Professional | 26 | $6.76 | $9.77 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.80 / $18.20 / $33.88
| Professional | TC | $13.80 | $18.20 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1.86 / $10.00 / $23.99
| Facility | 26 | $1.86 | $10.00 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $31.62 / $64.57
| Professional | | $19.50 | $31.62 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $10.47 / $20.89
| Professional | 26 | $6.31 | $10.47 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $21.88 / $44.67
| Professional | TC | $12.88 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $25.12 / $47.86
| Professional | | $19.05 | $25.12 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $8.32 / $15.85
| Professional | 26 | $6.31 | $8.32 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $16.60 / $32.36
| Professional | TC | $12.88 | $16.60 | $32.36 |