- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.87 / $32.24 / $32.24
| Facility | 26 | $16.87 | $32.24 | $32.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.60 / $47.12 / $97.47
| Professional | | $39.60 | $47.12 | $97.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.87 / $23.78 / $49.33
| Professional | 26 | $16.87 | $23.78 | $49.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.23 / $30.25 / $63.01
| Professional | TC | $18.23 | $30.25 | $63.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $33.61 / $54.87
| Professional | | $14.41 | $33.61 | $54.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.45 / $60.82 / $99.85
| Professional | | $40.45 | $60.82 | $99.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.95 / $30.20 / $43.08
| Professional | 26 | $21.95 | $30.20 | $43.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.09 / $26.31 / $55.46
| Professional | TC | $18.09 | $26.31 | $55.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.83 / $32.34 / $77.13
| Professional | | $28.83 | $32.34 | $77.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.80 / $62.72 / $135.34
| Professional | | $43.80 | $62.72 | $135.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.95 / $29.31 / $40.04
| Professional | 26 | $21.95 | $29.31 | $40.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.09 / $26.02 / $46.49
| Professional | TC | $18.09 | $26.02 | $46.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.60 / $65.31 / $90.34
| Professional | | $51.60 | $65.31 | $90.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.73 / $32.76 / $43.54
| Professional | 26 | $22.73 | $32.76 | $43.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.52 / $30.75 / $46.56
| Professional | TC | $23.52 | $30.75 | $46.56 |