- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.85 / $7.09 / $8.13
| Facility | 26 | $5.85 | $7.09 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $24.71 / $32.40
| Professional | | $15.48 | $24.71 | $32.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.80 / $5.03 / $7.09
| Professional | 26 | $2.80 | $5.03 | $7.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.62 / $19.69 / $25.31
| Professional | TC | $12.62 | $19.69 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.27 / $5.27 / $5.27
| Professional | 26 | $5.27 | $5.27 | $5.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.84 / $34.79 / $40.94
| Professional | | $27.84 | $34.79 | $40.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.09 / $7.62 / $8.96
| Professional | 26 | $6.09 | $7.62 | $8.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.75 / $27.18 / $31.98
| Professional | TC | $21.75 | $27.18 | $31.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.09 / $30.01 / $38.45
| Professional | | $16.09 | $30.01 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.08 / $6.79 / $9.53
| Professional | 26 | $3.08 | $6.79 | $9.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.98 / $22.55 / $30.04
| Professional | TC | $12.98 | $22.55 | $30.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.06 / $6.06 / $6.06
| Professional | 26 | $6.06 | $6.06 | $6.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.41 / $23.21 / $33.02
| Professional | | $18.41 | $23.21 | $33.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.89 / $5.29 / $8.15
| Professional | 26 | $3.89 | $5.29 | $8.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.49 / $18.25 / $26.71
| Professional | TC | $14.49 | $18.25 | $26.71 |