- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.05 / $19.53 / $34.25
| Facility | 26 | $16.05 | $19.53 | $34.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.59 / $43.94 / $80.03
| Professional | | $37.59 | $43.94 | $80.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.93 / $15.92 / $29.45
| Professional | 26 | $13.93 | $15.92 | $29.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.51 / $28.30 / $50.76
| Professional | TC | $23.51 | $28.30 | $50.76 |
- 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
- $41.39 / $54.85 / $88.83
| Professional | | $41.39 | $54.85 | $88.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.44 / $20.50 / $32.43
| Professional | 26 | $15.44 | $20.50 | $32.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.40 / $34.35 / $57.85
| Professional | TC | $25.40 | $34.35 | $57.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.82 / $18.82 / $18.82
| Facility | 26 | $18.82 | $18.82 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.50 / $59.80 / $99.82
| Professional | | $39.50 | $59.80 | $99.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.41 / $22.28 / $36.04
| Professional | 26 | $14.41 | $22.28 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.13 / $38.31 / $64.53
| Professional | TC | $24.13 | $38.31 | $64.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.96 / $53.79 / $87.54
| Professional | | $39.96 | $53.79 | $87.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.78 / $19.25 / $33.59
| Professional | 26 | $14.78 | $19.25 | $33.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.35 / $32.47 / $55.79
| Professional | TC | $24.35 | $32.47 | $55.79 |