- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Facility | 26 | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $36.31 / $79.43
| Professional | | $21.88 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.03 / $10.00 / $21.38
| Professional | 26 | $6.03 | $10.00 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $23.99 / $45.71
| Professional | TC | $15.14 | $23.99 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $22.91 / $25.12
| Professional | | $22.39 | $22.91 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.17 / $6.17 / $9.55
| Professional | 26 | $6.17 | $6.17 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $41.69 / $53.70
| Professional | | $28.84 | $41.69 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $13.80 / $17.38
| Professional | 26 | $9.55 | $13.80 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $27.54 / $35.48
| Professional | TC | $19.50 | $27.54 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $9.33 / $9.55
| Facility | 26 | $9.33 | $9.33 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $33.88 / $79.43
| Professional | | $21.88 | $33.88 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $10.96 / $22.39
| Professional | 26 | $7.59 | $10.96 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $26.30 / $58.88
| Professional | TC | $17.38 | $26.30 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $30.20 / $40.74
| Professional | | $21.88 | $30.20 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $8.51 / $12.88
| Professional | 26 | $6.61 | $8.51 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $21.38 / $28.84
| Professional | TC | $15.14 | $21.38 | $28.84 |