- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.26 / $21.95 / $21.95
| Facility | 26 | $16.26 | $21.95 | $21.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.07 / $38.07 / $56.29
| Professional | | $32.07 | $38.07 | $56.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.75 / $11.49 / $17.07
| Professional | 26 | $9.75 | $11.49 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.10 / $28.17 / $39.21
| Professional | TC | $22.10 | $28.17 | $39.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.67 / $43.04 / $43.04
| Professional | | $24.67 | $43.04 | $43.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $14.68 / $14.68
| Professional | 26 | $8.86 | $14.68 | $14.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.61 / $57.00 / $67.26
| Professional | | $41.61 | $57.00 | $67.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.73 / $17.44 / $20.58
| Professional | 26 | $12.73 | $17.44 | $20.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.88 / $39.56 / $46.68
| Professional | TC | $28.88 | $39.56 | $46.68 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $11.75 / $11.85
| Facility | 26 | $11.75 | $11.75 | $11.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.20 / $44.01 / $100.97
| Professional | | $31.20 | $44.01 | $100.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.76 / $14.04 / $29.66
| Professional | 26 | $9.76 | $14.04 | $29.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.97 / $32.61 / $71.31
| Professional | TC | $22.97 | $32.61 | $71.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.80 / $37.45 / $51.02
| Professional | | $28.80 | $37.45 | $51.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.09 / $12.34 / $15.59
| Professional | 26 | $9.09 | $12.34 | $15.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.71 / $25.69 / $36.85
| Professional | TC | $19.71 | $25.69 | $36.85 |