- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.39 / $14.11 / $20.23
| Facility | 26 | $12.39 | $14.11 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $44.28 / $70.66
| Professional | | $33.61 | $44.28 | $70.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.75 / $14.11 / $20.00
| Professional | 26 | $9.75 | $14.11 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.65 / $30.60 / $51.90
| Professional | TC | $24.65 | $30.60 | $51.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.25 / $12.63 / $13.20
| Professional | 26 | $11.25 | $12.63 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.26 / $54.25 / $68.48
| Professional | | $48.26 | $54.25 | $68.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.18 / $18.18 / $21.63
| Professional | 26 | $14.18 | $18.18 | $21.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.08 / $38.24 / $56.98
| Professional | TC | $34.08 | $38.24 | $56.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.98 / $12.17 / $25.02
| Professional | 26 | $10.98 | $12.17 | $25.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.56 / $42.49 / $72.95
| Professional | | $24.56 | $42.49 | $72.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.48 / $13.14 / $22.42
| Professional | 26 | $7.48 | $13.14 | $22.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.07 / $30.82 / $50.52
| Professional | TC | $17.07 | $30.82 | $50.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.10 / $40.36 / $67.94
| Professional | | $29.10 | $40.36 | $67.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.00 / $12.99 / $20.56
| Professional | 26 | $9.00 | $12.99 | $20.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.54 / $28.37 / $46.69
| Professional | TC | $20.54 | $28.37 | $46.69 |