- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.78 / $18.32 / $27.48
| Facility | 26 | $14.78 | $18.32 | $27.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.86 / $50.28 / $99.41
| Professional | | $41.86 | $50.28 | $99.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.29 / $15.82 / $35.17
| Professional | 26 | $13.29 | $15.82 | $35.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.49 / $34.03 / $65.05
| Professional | TC | $28.49 | $34.03 | $65.05 |
- 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
- $42.46 / $56.00 / $98.05
| Professional | | $42.46 | $56.00 | $98.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.88 / $20.60 / $32.11
| Professional | 26 | $14.88 | $20.60 | $32.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.66 / $39.20 / $68.30
| Professional | TC | $26.66 | $39.20 | $68.30 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.36 / $17.36 / $17.36
| Facility | 26 | $17.36 | $17.36 | $17.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.78 / $64.06 / $103.95
| Professional | | $42.78 | $64.06 | $103.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.63 / $21.83 / $35.35
| Professional | 26 | $13.63 | $21.83 | $35.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.30 / $42.04 / $71.55
| Professional | TC | $28.30 | $42.04 | $71.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.24 / $54.29 / $94.48
| Professional | | $44.24 | $54.29 | $94.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.62 / $18.25 / $32.63
| Professional | 26 | $14.62 | $18.25 | $32.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.57 / $36.33 / $61.73
| Professional | TC | $28.57 | $36.33 | $61.73 |