- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.89 / $19.89 / $19.89
| Facility | 26 | $19.89 | $19.89 | $19.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $26.05 / $39.01 / $39.08
| Facility | TC | $26.05 | $39.01 | $39.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.44 / $40.51 / $58.90
| Professional | | $33.44 | $40.51 | $58.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.68 / $14.44 / $19.89
| Professional | 26 | $11.68 | $14.44 | $19.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.75 / $26.05 / $39.01
| Professional | TC | $21.75 | $26.05 | $39.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.25 / $82.25 / $82.25
| Professional | | $82.25 | $82.25 | $82.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.19 / $61.91 / $73.05
| Professional | | $45.19 | $61.91 | $73.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.59 / $33.68 / $39.74
| Professional | 26 | $24.59 | $33.68 | $39.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.61 / $28.23 / $33.31
| Professional | TC | $20.61 | $28.23 | $33.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.70 / $44.86 / $76.37
| Professional | | $31.70 | $44.86 | $76.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.71 / $19.77 / $31.59
| Professional | 26 | $11.71 | $19.77 | $31.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.20 / $29.42 / $48.95
| Professional | TC | $22.20 | $29.42 | $48.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $41.66 / $57.03
| Professional | | $32.65 | $41.66 | $57.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.32 / $15.77 / $22.31
| Professional | 26 | $12.32 | $15.77 | $22.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.32 / $26.12 / $34.64
| Professional | TC | $19.32 | $26.12 | $34.64 |