- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.21 / $15.19 / $66.48
| Facility | 26 | $13.21 | $15.19 | $66.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.44 / $40.08 / $177.86
| Professional | | $30.44 | $40.08 | $177.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.06 / $13.21 / $24.89
| Professional | 26 | $9.06 | $13.21 | $24.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.39 / $26.88 / $48.59
| Professional | TC | $21.39 | $26.88 | $48.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.14 / $45.82 / $73.53
| Professional | | $35.14 | $45.82 | $73.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.07 / $15.19 / $21.96
| Professional | 26 | $11.07 | $15.19 | $21.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.72 / $30.99 / $51.57
| Professional | TC | $22.72 | $30.99 | $51.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $28.95 / $38.62
| Professional | | $22.10 | $28.95 | $38.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $147.24 / $147.24 / $147.24
| Facility | 26 | $147.24 | $147.24 | $147.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.55 / $63.65 / $72.29
| Professional | | $51.55 | $63.65 | $72.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.87 / $18.63 / $25.78
| Professional | 26 | $14.87 | $18.63 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.68 / $40.76 / $49.58
| Professional | TC | $36.68 | $40.76 | $49.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.92 / $37.44 / $61.10
| Professional | | $32.92 | $37.44 | $61.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.54 / $11.57 / $19.53
| Professional | 26 | $10.54 | $11.57 | $19.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.10 / $25.08 / $41.57
| Professional | TC | $22.10 | $25.08 | $41.57 |