- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.35 / $20.35 / $27.48
| Facility | 26 | $20.35 | $20.35 | $27.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.22 / $45.34 / $66.69
| Professional | | $38.22 | $45.34 | $66.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.51 / $14.63 / $21.37
| Professional | 26 | $12.51 | $14.63 | $21.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.72 / $30.34 / $45.31
| Professional | TC | $25.72 | $30.34 | $45.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.40 / $36.75 / $90.10
| Professional | | $29.40 | $36.75 | $90.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.28 / $14.10 / $18.68
| Professional | 26 | $11.28 | $14.10 | $18.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.86 / $82.00 / $96.76
| Professional | | $59.86 | $82.00 | $96.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.09 / $33.00 / $38.94
| Professional | 26 | $24.09 | $33.00 | $38.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.77 / $49.00 / $57.82
| Professional | TC | $35.77 | $49.00 | $57.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.72 / $17.72 / $17.88
| Facility | 26 | $17.72 | $17.72 | $17.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $51.94 / $119.31
| Professional | | $35.97 | $51.94 | $119.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.15 / $20.07 / $44.83
| Professional | 26 | $12.15 | $20.07 | $44.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.26 / $35.36 / $81.52
| Professional | TC | $24.26 | $35.36 | $81.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.58 / $45.68 / $62.84
| Professional | | $34.58 | $45.68 | $62.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.18 / $15.65 / $21.91
| Professional | 26 | $12.18 | $15.65 | $21.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.46 / $29.71 / $40.79
| Professional | TC | $22.46 | $29.71 | $40.79 |