- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $7.33 / $15.44
| Facility | 26 | $7.33 | $7.33 | $15.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $21.21 / $23.34
| Professional | | $13.18 | $21.21 | $23.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $9.73 / $15.54
| Professional | 26 | $7.33 | $9.73 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.85 / $10.11 / $12.62
| Professional | TC | $5.85 | $10.11 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.14 / $15.34 / $28.22
| Professional | | $8.14 | $15.34 | $28.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $28.70 / $37.06
| Professional | | $16.72 | $28.70 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.53 / $13.48 / $18.12
| Professional | 26 | $8.53 | $13.48 | $18.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.57 / $13.56 / $19.17
| Professional | TC | $7.57 | $13.56 | $19.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.75 / $22.76 / $32.34
| Professional | | $9.75 | $22.76 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.62 / $32.43 / $41.25
| Professional | | $17.62 | $32.43 | $41.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.53 / $13.48 / $17.64
| Professional | 26 | $8.53 | $13.48 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.63 / $13.56 / $19.17
| Professional | TC | $7.63 | $13.56 | $19.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.48 / $26.46 / $48.44
| Professional | | $19.48 | $26.46 | $48.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.88 / $10.83 / $25.29
| Professional | 26 | $9.88 | $10.83 | $25.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.66 / $13.85 / $23.40
| Professional | TC | $8.66 | $13.85 | $23.40 |