- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.09 / $20.35 / $20.36
| Facility | 26 | $14.09 | $20.35 | $20.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $47.68 / $66.84
| Professional | | $38.36 | $47.68 | $66.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.70 / $14.36 / $20.36
| Professional | 26 | $11.70 | $14.36 | $20.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.67 / $34.09 / $46.48
| Professional | TC | $26.67 | $34.09 | $46.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.74 / $38.42 / $39.10
| Professional | | $30.74 | $38.42 | $39.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.28 / $11.28 / $14.15
| Professional | 26 | $11.28 | $11.28 | $14.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.39 / $74.50 / $87.91
| Professional | | $54.39 | $74.50 | $87.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.62 / $25.50 / $30.09
| Professional | 26 | $18.62 | $25.50 | $30.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.77 / $49.00 / $57.82
| Professional | TC | $35.77 | $49.00 | $57.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.37 / $17.37 / $17.52
| Facility | 26 | $17.37 | $17.37 | $17.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.32 / $55.90 / $125.59
| Professional | | $39.32 | $55.90 | $125.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.40 / $20.23 / $41.00
| Professional | 26 | $12.40 | $20.23 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.53 / $39.95 / $87.80
| Professional | TC | $26.53 | $39.95 | $87.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.97 / $49.37 / $66.29
| Professional | | $38.97 | $49.37 | $66.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.45 / $15.77 / $21.27
| Professional | 26 | $12.45 | $15.77 | $21.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.21 / $32.01 / $46.78
| Professional | TC | $25.21 | $32.01 | $46.78 |