- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.30 / $10.21 / $22.41
| Facility | 26 | $9.30 | $10.21 | $22.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.38 / $38.51 / $69.33
| Professional | | $31.38 | $38.51 | $69.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.22 / $9.60 / $22.41
| Professional | 26 | $8.22 | $9.60 | $22.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.08 / $26.67 / $49.54
| Professional | TC | $22.08 | $26.67 | $49.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.40 / $77.20 / $77.20
| Professional | | $26.40 | $77.20 | $77.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $10.03 / $24.73
| Professional | 26 | $7.95 | $10.03 | $24.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.51 / $26.51 / $26.51
| Professional | TC | $26.51 | $26.51 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Professional | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.21 / $46.44 / $64.79
| Professional | | $29.21 | $46.44 | $64.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.18 / $14.79 / $18.69
| Professional | 26 | $9.18 | $14.79 | $18.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.02 / $32.22 / $46.68
| Professional | TC | $20.02 | $32.22 | $46.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.01 / $32.34 / $32.34
| Professional | | $9.01 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.73 / $40.81 / $69.37
| Professional | | $26.73 | $40.81 | $69.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.91 / $12.62 / $20.01
| Professional | 26 | $7.91 | $12.62 | $20.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.26 / $27.45 / $49.79
| Professional | TC | $19.26 | $27.45 | $49.79 |