- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.76 / $22.76 / $26.40
| Facility | 26 | $22.76 | $22.76 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.85 / $54.57 / $81.41
| Professional | | $29.85 | $54.57 | $81.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.55 / $22.29 / $27.74
| Professional | 26 | $19.55 | $22.29 | $27.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.60 / $31.63 / $41.33
| Professional | TC | $9.60 | $31.63 | $41.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.31 / $38.04 / $60.31
| Professional | | $27.31 | $38.04 | $60.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.19 / $26.06 / $41.30
| Professional | 26 | $19.19 | $26.06 | $41.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.61 / $13.19 / $19.47
| Professional | TC | $8.61 | $13.19 | $19.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.94 / $31.01 / $58.99
| Professional | | $19.94 | $31.01 | $58.99 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.51 / $23.51 / $23.51
| Facility | 26 | $23.51 | $23.51 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.08 / $52.60 / $89.65
| Professional | | $36.08 | $52.60 | $89.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.94 / $28.08 / $45.11
| Professional | 26 | $21.94 | $28.08 | $45.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.27 / $20.26 / $52.96
| Professional | TC | $11.27 | $20.26 | $52.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.60 / $42.07 / $67.88
| Professional | | $29.60 | $42.07 | $67.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.28 / $22.38 / $36.90
| Professional | 26 | $18.28 | $22.38 | $36.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.82 / $21.56 / $35.50
| Professional | TC | $8.82 | $21.56 | $35.50 |