- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.74 / $11.74 / $11.74
| Facility | 26 | $11.74 | $11.74 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $28.26 / $41.21
| Professional | | $23.65 | $28.26 | $41.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.81 / $8.25 / $11.74
| Professional | 26 | $6.81 | $8.25 | $11.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.84 / $20.01 / $29.47
| Professional | TC | $16.84 | $20.01 | $29.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.17 / $22.17 / $22.17
| Professional | | $22.17 | $22.17 | $22.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.00 / $8.00 / $8.00
| Professional | 26 | $8.00 | $8.00 | $8.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.77 / $29.82 / $35.19
| Professional | | $21.77 | $29.82 | $35.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.16 / $8.44 / $9.96
| Professional | 26 | $6.16 | $8.44 | $9.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.61 / $21.38 / $25.23
| Professional | TC | $15.61 | $21.38 | $25.23 |
- 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
- $22.07 / $31.83 / $75.34
| Professional | | $22.07 | $31.83 | $75.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.77 / $10.63 / $21.38
| Professional | 26 | $6.77 | $10.63 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.63 / $23.61 / $56.39
| Professional | TC | $16.63 | $23.61 | $56.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.78 / $29.03 / $37.68
| Professional | | $21.78 | $29.03 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.50 / $8.32 / $11.65
| Professional | 26 | $6.50 | $8.32 | $11.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.44 / $20.14 / $27.04
| Professional | TC | $14.44 | $20.14 | $27.04 |