- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.19 / $23.20 / $23.20
| Facility | 26 | $17.19 | $23.20 | $23.20 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $25.20 / $37.77 / $50.98
| Facility | TC | $25.20 | $37.77 | $50.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.41 / $37.78 / $57.70
| Professional | | $31.41 | $37.78 | $57.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.90 / $12.12 / $18.04
| Professional | 26 | $9.90 | $12.12 | $18.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.51 / $25.66 / $39.65
| Professional | TC | $21.51 | $25.66 | $39.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.11 / $25.11 / $25.11
| Professional | | $25.11 | $25.11 | $25.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.38 / $9.38 / $22.87
| Professional | 26 | $9.38 | $9.38 | $22.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.56 / $72.00 / $84.96
| Professional | | $52.56 | $72.00 | $84.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.41 / $29.33 / $34.61
| Professional | 26 | $21.41 | $29.33 | $34.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.15 / $42.67 / $50.35
| Professional | TC | $31.15 | $42.67 | $50.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.54 / $42.13 / $71.26
| Professional | | $29.54 | $42.13 | $71.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.33 / $16.61 / $26.53
| Professional | 26 | $10.33 | $16.61 | $26.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.89 / $29.00 / $48.27
| Professional | TC | $21.89 | $29.00 | $48.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.22 / $40.11 / $53.15
| Professional | | $30.22 | $40.11 | $53.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.29 / $13.04 / $19.26
| Professional | 26 | $10.29 | $13.04 | $19.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $25.79 / $34.21
| Professional | TC | $19.05 | $25.79 | $34.21 |