- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.33 / $10.81 / $10.81
| Facility | 26 | $7.33 | $10.81 | $10.81 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $18.18 / $26.15 / $27.82
| Facility | TC | $18.18 | $26.15 | $27.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.65 / $25.50 / $38.79
| Professional | | $21.65 | $25.50 | $38.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.28 / $7.57 / $11.35
| Professional | 26 | $6.28 | $7.57 | $11.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.37 / $18.17 / $27.45
| Professional | TC | $15.37 | $18.17 | $27.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.34 / $17.34 / $22.17
| Professional | | $17.34 | $17.34 | $22.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.98 / $6.84 / $14.48
| Professional | 26 | $5.98 | $6.84 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.07 / $27.50 / $32.45
| Professional | | $20.07 | $27.50 | $32.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.04 / $8.27 / $9.77
| Professional | 26 | $6.04 | $8.27 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.03 / $19.22 / $22.68
| Professional | TC | $14.03 | $19.22 | $22.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.58 / $32.60 / $69.79
| Professional | | $22.58 | $32.60 | $69.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.46 / $10.58 / $19.68
| Professional | 26 | $6.46 | $10.58 | $19.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.13 / $22.02 / $50.10
| Professional | TC | $16.13 | $22.02 | $50.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.33 / $26.82 / $37.54
| Professional | | $21.33 | $26.82 | $37.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.50 / $8.24 / $11.60
| Professional | 26 | $6.50 | $8.24 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.65 / $18.91 / $25.51
| Professional | TC | $14.65 | $18.91 | $25.51 |