- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.35 / $16.54 / $26.77
| Facility | 26 | $12.35 | $16.54 | $26.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.42 / $58.28 / $142.54
| Professional | | $45.42 | $58.28 | $142.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.74 / $15.96 / $40.33
| Professional | 26 | $11.74 | $15.96 | $40.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.17 / $41.42 / $80.22
| Professional | TC | $33.17 | $41.42 | $80.22 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.78 / $16.78 / $16.78
| Facility | 26 | $16.78 | $16.78 | $16.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.90 / $62.10 / $100.59
| Professional | | $46.90 | $62.10 | $100.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.29 / $17.92 / $27.81
| Professional | 26 | $12.29 | $17.92 | $27.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.29 / $44.43 / $74.65
| Professional | TC | $33.29 | $44.43 | $74.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $14.26 / $14.26
| Facility | 26 | $14.26 | $14.26 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.20 / $69.04 / $111.44
| Professional | | $44.20 | $69.04 | $111.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.26 / $19.19 / $32.86
| Professional | 26 | $12.26 | $19.19 | $32.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.69 / $48.99 / $82.93
| Professional | TC | $33.69 | $48.99 | $82.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.19 / $55.92 / $97.76
| Professional | | $45.19 | $55.92 | $97.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.69 / $16.14 / $28.45
| Professional | 26 | $12.69 | $16.14 | $28.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.22 / $39.90 / $70.56
| Professional | TC | $32.22 | $39.90 | $70.56 |