- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.33 / $7.78 / $15.28
| Facility | 26 | $6.33 | $7.78 | $15.28 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $10.98 / $21.36 / $40.00
| Facility | TC | $10.98 | $21.36 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.30 / $23.58 / $41.22
| Professional | | $17.30 | $23.58 | $41.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.42 / $7.13 / $15.28
| Professional | 26 | $6.42 | $7.13 | $15.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.98 / $17.38 / $25.94
| Professional | TC | $10.98 | $17.38 | $25.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.19 / $17.19 / $17.19
| Professional | | $17.19 | $17.19 | $17.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.40 / $6.88 / $16.88
| Professional | 26 | $5.40 | $6.88 | $16.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.96 / $11.96 / $11.96
| Professional | TC | $11.96 | $11.96 | $11.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $38.00 / $38.00
| Professional | | $38.00 | $38.00 | $38.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $32.36 / $44.99
| Professional | | $17.70 | $32.36 | $44.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.27 / $11.65 / $15.21
| Professional | 26 | $6.27 | $11.65 | $15.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.44 / $20.44 / $28.50
| Professional | TC | $11.44 | $20.44 | $28.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.16 / $32.34 / $32.34
| Professional | | $6.16 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $23.23 / $42.91
| Professional | | $18.32 | $23.23 | $42.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.15 / $8.97 / $15.76
| Professional | 26 | $6.15 | $8.97 | $15.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.61 / $14.14 / $27.45
| Professional | TC | $11.61 | $14.14 | $27.45 |