- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $10.00 / $22.91
| Facility | 26 | $9.33 | $10.00 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $38.90 / $72.44
| Professional | | $30.90 | $38.90 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $10.96 / $22.91
| Professional | 26 | $8.71 | $10.96 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.84 / $50.12
| Professional | TC | $21.88 | $28.84 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $31.62 / $79.43
| Professional | | $30.90 | $31.62 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.96 / $16.98
| Professional | 26 | $7.94 | $10.96 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $26.30 / $47.86
| Professional | TC | $22.39 | $26.30 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Professional | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $45.71 / $64.57
| Professional | | $26.92 | $45.71 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $14.45 / $19.50
| Professional | 26 | $7.76 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $31.62 / $46.77
| Professional | TC | $19.50 | $31.62 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $32.36 / $33.11
| Professional | | $21.38 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $38.90 / $63.10
| Professional | | $25.70 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $11.48 / $19.50
| Professional | 26 | $7.94 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $26.92 / $43.65
| Professional | TC | $18.20 | $26.92 | $43.65 |