- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.43 / $20.91 / $23.94
| Facility | 26 | $11.43 | $20.91 | $23.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.22 / $54.12 / $261.05
| Professional | | $42.22 | $54.12 | $261.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.43 / $15.11 / $37.90
| Professional | 26 | $11.43 | $15.11 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.66 / $38.60 / $69.54
| Professional | TC | $27.66 | $38.60 | $69.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.10 / $36.11 / $61.93
| Professional | | $11.10 | $36.11 | $61.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.07 / $66.09 / $96.84
| Professional | | $44.07 | $66.09 | $96.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.53 / $20.04 / $28.63
| Professional | 26 | $13.53 | $20.04 | $28.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.04 / $46.06 / $67.56
| Professional | TC | $31.04 | $46.06 | $67.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.02 / $32.34 / $61.52
| Professional | | $19.02 | $32.34 | $61.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.84 / $81.13 / $116.86
| Professional | | $50.84 | $81.13 | $116.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.54 / $20.07 / $27.36
| Professional | 26 | $13.54 | $20.07 | $27.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.34 / $47.27 / $67.56
| Professional | TC | $31.34 | $47.27 | $67.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.58 / $54.12 / $120.61
| Professional | | $51.58 | $54.12 | $120.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.31 / $16.60 / $36.34
| Professional | 26 | $15.31 | $16.60 | $36.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.36 / $37.52 / $75.25
| Professional | TC | $35.36 | $37.52 | $75.25 |