- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.46 / $18.37 / $31.43
| Facility | 26 | $14.46 | $18.37 | $31.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $55.15 / $82.33
| Professional | | $34.04 | $55.15 | $82.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.00 / $15.03 / $32.35
| Professional | 26 | $13.00 | $15.03 | $32.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.10 / $36.78 / $54.11
| Professional | TC | $21.10 | $36.78 | $54.11 |
- 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
- $38.06 / $58.89 / $96.72
| Professional | | $38.06 | $58.89 | $96.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.56 / $20.36 / $31.79
| Professional | 26 | $14.56 | $20.36 | $31.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.70 / $37.52 / $69.60
| Professional | TC | $23.70 | $37.52 | $69.60 |
- 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
- $37.11 / $66.06 / $111.57
| Professional | | $37.11 | $66.06 | $111.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.63 / $21.57 / $35.33
| Professional | 26 | $13.63 | $21.57 | $35.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.15 / $45.08 / $77.36
| Professional | TC | $23.15 | $45.08 | $77.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $56.18 / $91.03
| Professional | | $38.36 | $56.18 | $91.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.62 / $18.73 / $32.15
| Professional | 26 | $14.62 | $18.73 | $32.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.16 / $34.68 / $63.07
| Professional | TC | $22.16 | $34.68 | $63.07 |