- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.21 / $33.36 / $38.20
| Facility | 26 | $17.21 | $33.36 | $38.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.49 / $70.65 / $150.76
| Professional | | $27.49 | $70.65 | $150.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.38 / $24.92 / $55.66
| Professional | 26 | $23.38 | $24.92 | $55.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.32 / $47.17 / $95.08
| Professional | TC | $17.32 | $47.17 | $95.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.26 / $36.08 / $72.95
| Professional | | $22.26 | $36.08 | $72.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.48 / $100.77 / $138.77
| Professional | | $66.48 | $100.77 | $138.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.23 / $37.54 / $49.71
| Professional | 26 | $28.23 | $37.54 | $49.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.17 / $67.98 / $89.06
| Professional | TC | $24.17 | $67.98 | $89.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.05 / $32.34 / $76.37
| Professional | | $28.05 | $32.34 | $76.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.96 / $98.49 / $138.77
| Professional | | $55.96 | $98.49 | $138.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.56 / $37.54 / $49.71
| Professional | 26 | $30.56 | $37.54 | $49.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.17 / $63.63 / $89.06
| Professional | TC | $24.17 | $63.63 | $89.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.45 / $97.38 / $116.04
| Professional | | $60.45 | $97.38 | $116.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.68 / $33.82 / $47.85
| Professional | 26 | $30.68 | $33.82 | $47.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.77 / $63.56 / $76.92
| Professional | TC | $29.77 | $63.56 | $76.92 |