- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.97 / $20.30 / $27.40
| Facility | 26 | $8.97 | $20.30 | $27.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.84 / $54.75 / $70.68
| Professional | | $31.84 | $54.75 | $70.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $13.64 / $21.31
| Professional | 26 | $7.33 | $13.64 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.79 / $34.45 / $63.35
| Professional | TC | $19.79 | $34.45 | $63.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.91 / $16.51 / $16.51
| Professional | 26 | $10.91 | $16.51 | $16.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.45 / $54.04 / $63.77
| Professional | | $39.45 | $54.04 | $63.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.07 / $15.16 / $17.89
| Professional | 26 | $11.07 | $15.16 | $17.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.38 / $38.88 / $45.88
| Professional | TC | $28.38 | $38.88 | $45.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $9.38 / $9.46
| Facility | 26 | $9.38 | $9.38 | $9.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.39 / $59.71 / $138.81
| Professional | | $33.39 | $59.71 | $138.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.93 / $12.06 / $30.00
| Professional | 26 | $8.93 | $12.06 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.82 / $48.72 / $116.60
| Professional | TC | $21.82 | $48.72 | $116.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.79 / $42.59 / $100.59
| Professional | | $32.79 | $42.59 | $100.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.25 / $13.02 / $18.14
| Professional | 26 | $7.25 | $13.02 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.56 / $26.71 / $84.72
| Professional | TC | $20.56 | $26.71 | $84.72 |