- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.09 / $14.24 / $16.20
| Facility | 26 | $7.09 | $14.24 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $32.24 / $47.42
| Professional | | $22.77 | $32.24 | $47.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.56 / $7.52 / $14.24
| Professional | 26 | $6.56 | $7.52 | $14.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.51 / $23.57 / $33.17
| Professional | TC | $16.51 | $23.57 | $33.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $23.61 / $52.70
| Professional | | $23.61 | $23.61 | $52.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.88 / $7.26 / $16.20
| Professional | 26 | $6.88 | $7.26 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.00 / $53.00 / $53.00
| Professional | | $53.00 | $53.00 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.52 / $40.63 / $65.26
| Professional | | $24.52 | $40.63 | $65.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $11.00 / $17.60
| Professional | 26 | $7.33 | $11.00 | $17.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.85 / $26.73 / $47.23
| Professional | TC | $17.85 | $26.73 | $47.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.15 / $32.34 / $32.34
| Professional | | $13.15 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.01 / $33.94 / $81.61
| Professional | | $23.01 | $33.94 | $81.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.44 / $8.63 / $19.98
| Professional | 26 | $6.44 | $8.63 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.98 / $20.85 / $52.80
| Professional | TC | $15.98 | $20.85 | $52.80 |