- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.07 / $22.09 / $78.94
| Facility | 26 | $21.07 | $22.09 | $78.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.79 / $48.25 / $84.48
| Professional | | $37.79 | $48.25 | $84.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.17 / $23.04 / $36.03
| Professional | 26 | $19.17 | $23.04 | $36.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.44 / $26.36 / $57.56
| Professional | TC | $16.44 | $26.36 | $57.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.23 / $18.23 / $18.23
| Professional | 26 | $18.23 | $18.23 | $18.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.93 / $64.95 / $79.83
| Professional | | $37.93 | $64.95 | $79.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.67 / $25.33 / $36.72
| Professional | 26 | $18.67 | $25.33 | $36.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.69 / $38.64 / $49.68
| Professional | TC | $17.69 | $38.64 | $49.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.22 / $25.22 / $25.22
| Professional | 26 | $25.22 | $25.22 | $25.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.47 / $55.43 / $95.10
| Professional | | $39.47 | $55.43 | $95.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.37 / $23.93 / $39.20
| Professional | 26 | $17.37 | $23.93 | $39.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.12 / $33.47 / $56.49
| Professional | TC | $20.12 | $33.47 | $56.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.43 / $40.59 / $69.09
| Professional | | $31.43 | $40.59 | $69.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.73 / $20.09 / $34.68
| Professional | 26 | $14.73 | $20.09 | $34.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.21 / $21.37 / $36.03
| Professional | TC | $13.21 | $21.37 | $36.03 |