- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.99 / $9.86 / $21.68
| Facility | 26 | $8.99 | $9.86 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.26 / $42.81 / $72.44
| Professional | | $30.26 | $42.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.99 / $11.79 / $21.68
| Professional | 26 | $8.99 | $11.79 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.27 / $30.45 / $50.77
| Professional | TC | $21.27 | $30.45 | $50.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.71 / $25.71 / $29.24
| Professional | | $25.71 | $25.71 | $29.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.66 / $9.71 / $18.14
| Professional | 26 | $7.66 | $9.71 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.05 / $22.83 / $25.28
| Professional | TC | $18.05 | $22.83 | $25.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Professional | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.81 / $53.18 / $73.84
| Professional | | $30.81 | $53.18 | $73.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $18.82 / $24.72
| Professional | 26 | $8.90 | $18.82 | $24.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.24 / $34.36 / $49.73
| Professional | TC | $21.24 | $34.36 | $49.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.72 / $32.34 / $32.34
| Professional | | $8.72 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.04 / $39.85 / $74.34
| Professional | | $29.04 | $39.85 | $74.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.84 / $12.71 / $24.55
| Professional | 26 | $9.84 | $12.71 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.51 / $26.56 / $49.07
| Professional | TC | $20.51 | $26.56 | $49.07 |