- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.56 / $16.80 / $27.27
| Facility | 26 | $14.56 | $16.80 | $27.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.43 / $60.35 / $126.11
| Professional | | $51.43 | $60.35 | $126.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.29 / $15.87 / $36.88
| Professional | 26 | $13.29 | $15.87 | $36.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.11 / $43.09 / $82.17
| Professional | TC | $37.11 | $43.09 | $82.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.14 / $17.14 / $17.14
| Facility | 26 | $17.14 | $17.14 | $17.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.29 / $69.53 / $116.00
| Professional | | $53.29 | $69.53 | $116.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.56 / $19.91 / $30.22
| Professional | 26 | $14.56 | $19.91 | $30.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.44 / $53.22 / $84.93
| Professional | TC | $40.44 | $53.22 | $84.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.32 / $17.32 / $17.32
| Facility | 26 | $17.32 | $17.32 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $75.83 / $132.59
| Professional | | $52.44 | $75.83 | $132.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.64 / $21.68 / $35.39
| Professional | 26 | $13.64 | $21.68 | $35.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.09 / $56.09 / $96.31
| Professional | TC | $38.09 | $56.09 | $96.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.69 / $66.04 / $118.32
| Professional | | $53.69 | $66.04 | $118.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.09 / $18.88 / $32.51
| Professional | 26 | $15.09 | $18.88 | $32.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.96 / $49.29 / $84.56
| Professional | TC | $37.96 | $49.29 | $84.56 |