- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.76 / $28.76 / $52.65
| Facility | 26 | $28.76 | $28.76 | $52.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.50 / $23.22 / $23.22
| Professional | | $21.50 | $23.22 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.38 / $16.96 / $74.73
| Professional | 26 | $16.38 | $16.96 | $74.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.12 / $6.27 / $6.27
| Professional | TC | $5.12 | $6.27 | $6.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.66 / $29.66 / $50.07
| Professional | | $29.66 | $29.66 | $50.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.64 / $20.92 / $29.72
| Professional | 26 | $14.64 | $20.92 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.12 / $7.43 / $8.74
| Professional | TC | $6.12 | $7.43 | $8.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.02 / $39.72 / $52.48
| Professional | | $15.02 | $39.72 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $30.81 / $37.29
| Professional | 26 | $11.22 | $30.81 | $37.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.81 / $9.58 / $15.70
| Professional | TC | $3.81 | $9.58 | $15.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $31.40 / $47.54
| Professional | | $13.94 | $31.40 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.01 / $26.43 / $36.04
| Professional | 26 | $11.01 | $26.43 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.34 / $9.08 / $11.78
| Professional | TC | $3.34 | $9.08 | $11.78 |