- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $7.24 / $12.88
| Facility | 26 | $7.08 | $7.24 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.11 / $72.44
| Professional | | $25.12 | $33.11 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $7.94 / $20.42
| Professional | 26 | $7.08 | $7.94 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $25.12 / $43.65
| Professional | TC | $18.62 | $25.12 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $25.70 / $48.98
| Professional | | $19.50 | $25.70 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.17 / $7.76 / $11.48
| Professional | 26 | $6.17 | $7.76 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $19.50 / $25.12
| Professional | TC | $17.78 | $19.50 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Professional | | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $38.90 / $58.88
| Professional | | $22.39 | $38.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $12.30 / $17.38
| Professional | 26 | $6.76 | $12.30 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $27.54 / $41.69
| Professional | TC | $17.38 | $27.54 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $32.36 / $33.11
| Professional | | $17.78 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $32.36 / $61.66
| Professional | | $23.44 | $32.36 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.12 / $17.38
| Professional | 26 | $7.08 | $9.12 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $22.91 / $43.65
| Professional | TC | $16.22 | $22.91 | $43.65 |