- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.27 / $12.90 / $22.20
| Facility | 26 | $11.27 | $12.90 | $22.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.76 / $29.72 / $35.97
| Professional | | $25.76 | $29.72 | $35.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.48 / $9.39 / $11.57
| Professional | 26 | $8.48 | $9.39 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.28 / $20.34 / $27.60
| Professional | TC | $17.28 | $20.34 | $27.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.02 / $52.02 / $52.02
| Professional | | $52.02 | $52.02 | $52.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.25 / $40.98 / $59.00
| Professional | | $23.25 | $40.98 | $59.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.82 / $14.07 / $19.39
| Professional | 26 | $8.82 | $14.07 | $19.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.32 / $28.37 / $42.51
| Professional | TC | $15.32 | $28.37 | $42.51 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.21 / $22.21 / $80.00
| Facility | 26 | $22.21 | $22.21 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.40 / $42.37 / $197.88
| Professional | | $24.40 | $42.37 | $197.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.45 / $12.96 / $232.03
| Professional | 26 | $7.45 | $12.96 | $232.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.95 / $28.06 / $142.29
| Professional | TC | $16.95 | $28.06 | $142.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.40 / $36.11 / $55.83
| Professional | | $24.40 | $36.11 | $55.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.45 / $11.40 / $22.46
| Professional | 26 | $7.45 | $11.40 | $22.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.95 / $22.93 / $39.44
| Professional | TC | $16.95 | $22.93 | $39.44 |