- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.16 / $14.61 / $26.10
| Facility | 26 | $11.16 | $14.61 | $26.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.78 / $52.37 / $101.85
| Professional | | $43.78 | $52.37 | $101.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.78 / $11.36 / $23.34
| Professional | 26 | $9.78 | $11.36 | $23.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.15 / $39.11 / $72.16
| Professional | TC | $33.15 | $39.11 | $72.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.27 / $13.27 / $13.27
| Facility | 26 | $13.27 | $13.27 | $13.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.60 / $59.36 / $96.33
| Professional | | $43.60 | $59.36 | $96.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.13 / $15.56 / $22.99
| Professional | 26 | $11.13 | $15.56 | $22.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.26 / $44.62 / $74.19
| Professional | TC | $32.26 | $44.62 | $74.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.10 / $13.10 / $13.10
| Facility | 26 | $13.10 | $13.10 | $13.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.30 / $64.12 / $109.47
| Professional | | $44.30 | $64.12 | $109.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.68 / $16.39 / $26.64
| Professional | 26 | $10.68 | $16.39 | $26.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.59 / $48.63 / $86.70
| Professional | TC | $32.59 | $48.63 | $86.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.64 / $56.52 / $98.90
| Professional | | $44.64 | $56.52 | $98.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.29 / $14.19 / $24.46
| Professional | 26 | $11.29 | $14.19 | $24.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.90 / $42.80 / $74.80
| Professional | TC | $32.90 | $42.80 | $74.80 |