- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.30 / $19.54 / $20.32
| Facility | 26 | $17.30 | $19.54 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.57 / $44.18 / $95.90
| Professional | | $36.57 | $44.18 | $95.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.75 / $17.51 / $37.96
| Professional | 26 | $16.75 | $17.51 | $37.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.07 / $26.66 / $57.94
| Professional | TC | $18.07 | $26.66 | $57.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.94 / $49.00 / $67.28
| Professional | | $22.94 | $49.00 | $67.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.47 / $52.65 / $84.37
| Professional | | $32.47 | $52.65 | $84.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.78 / $28.57 / $38.74
| Professional | 26 | $19.78 | $28.57 | $38.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.75 / $29.92 / $41.57
| Professional | TC | $10.75 | $29.92 | $41.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.04 / $48.04 / $92.34
| Facility | 26 | $48.04 | $48.04 | $92.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.14 / $45.96 / $105.92
| Professional | | $32.14 | $45.96 | $105.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.23 / $23.11 / $132.09
| Professional | 26 | $18.23 | $23.11 | $132.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.10 / $22.61 / $222.93
| Professional | TC | $9.10 | $22.61 | $222.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $43.48 / $67.79
| Professional | | $30.01 | $43.48 | $67.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.91 / $22.53 / $40.11
| Professional | 26 | $17.91 | $22.53 | $40.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.98 / $22.08 / $35.71
| Professional | TC | $8.98 | $22.08 | $35.71 |