- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $10.96 / $20.42
| Facility | 26 | $10.96 | $10.96 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $43.65 / $85.11
| Professional | | $33.88 | $43.65 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $12.02 / $28.18
| Professional | 26 | $10.00 | $12.02 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $30.20 / $47.86
| Professional | TC | $22.91 | $30.20 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $43.65 / $61.66
| Professional | | $22.91 | $43.65 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $13.49 / $30.20
| Professional | 26 | $9.33 | $13.49 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $25.70 / $32.36
| Professional | TC | $25.12 | $25.70 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Professional | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $52.48 / $72.44
| Professional | | $29.51 | $52.48 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $18.20 / $26.30
| Professional | 26 | $9.12 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $33.88 / $45.71
| Professional | TC | $20.42 | $33.88 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $32.36 / $33.11
| Professional | | $22.91 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $42.66 / $75.86
| Professional | | $29.51 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $14.79 / $27.54
| Professional | 26 | $10.96 | $14.79 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $28.18 / $46.77
| Professional | TC | $19.05 | $28.18 | $46.77 |