- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.00 / $15.06 / $23.16
| Facility | 26 | $12.00 | $15.06 | $23.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.09 / $41.11 / $85.74
| Professional | | $35.09 | $41.11 | $85.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.91 / $13.27 / $31.55
| Professional | 26 | $10.91 | $13.27 | $31.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.26 / $27.51 / $57.56
| Professional | TC | $23.26 | $27.51 | $57.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $14.26 / $14.26
| Facility | 26 | $14.26 | $14.26 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.88 / $47.76 / $79.78
| Professional | | $36.88 | $47.76 | $79.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.97 / $16.35 / $24.84
| Professional | 26 | $11.97 | $16.35 | $24.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.90 / $34.35 / $54.80
| Professional | TC | $25.90 | $34.35 | $54.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $14.26 / $14.26
| Facility | 26 | $14.26 | $14.26 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.52 / $52.26 / $92.26
| Professional | | $36.52 | $52.26 | $92.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.25 / $17.98 / $29.89
| Professional | 26 | $11.25 | $17.98 | $29.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.41 / $35.53 / $62.65
| Professional | TC | $24.41 | $35.53 | $62.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.63 / $45.81 / $86.12
| Professional | | $36.63 | $45.81 | $86.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $15.60 / $26.58
| Professional | 26 | $12.59 | $15.60 | $26.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.12 / $31.36 / $54.07
| Professional | TC | $24.12 | $31.36 | $54.07 |