- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.29 / $13.08 / $13.09
| Facility | 26 | $11.29 | $13.08 | $13.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.19 / $26.95 / $39.24
| Professional | | $23.19 | $26.95 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.58 / $8.80 / $13.74
| Professional | 26 | $7.58 | $8.80 | $13.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.61 / $18.39 / $26.15
| Professional | TC | $15.61 | $18.39 | $26.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $21.62 / $21.62
| Professional | | $21.62 | $21.62 | $21.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.38 / $30.66 / $36.18
| Professional | | $22.38 | $30.66 | $36.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $10.66 / $12.58
| Professional | 26 | $7.78 | $10.66 | $12.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.60 / $20.00 / $23.60
| Professional | TC | $14.60 | $20.00 | $23.60 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.81 / $11.81 / $11.91
| Facility | 26 | $11.81 | $11.81 | $11.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.63 / $32.93 / $74.73
| Professional | | $21.63 | $32.93 | $74.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $13.25 / $27.00
| Professional | 26 | $7.59 | $13.25 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.34 / $21.21 / $50.89
| Professional | TC | $15.34 | $21.21 | $50.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.69 / $29.87 / $45.79
| Professional | | $20.69 | $29.87 | $45.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.45 / $10.03 / $14.17
| Professional | 26 | $7.45 | $10.03 | $14.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.03 / $20.13 / $29.60
| Professional | TC | $14.03 | $20.13 | $29.60 |