- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.06 / $14.34 / $14.91
| Facility | 26 | $12.06 | $14.34 | $14.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.11 / $37.57 / $81.53
| Professional | | $37.11 | $37.57 | $81.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.63 / $12.20 / $26.40
| Professional | 26 | $11.63 | $12.20 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.07 / $25.37 / $55.13
| Professional | TC | $25.07 | $25.37 | $55.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.16 / $25.01 / $81.75
| Professional | | $17.16 | $25.01 | $81.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.67 / $64.73 / $90.39
| Professional | | $42.67 | $64.73 | $90.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.23 / $20.27 / $28.26
| Professional | 26 | $14.23 | $20.27 | $28.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.72 / $44.45 / $62.13
| Professional | TC | $27.72 | $44.45 | $62.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.90 / $32.90 / $80.00
| Facility | 26 | $32.90 | $32.90 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.15 / $54.30 / $119.81
| Professional | | $42.15 | $54.30 | $119.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $16.47 / $91.83
| Professional | 26 | $12.88 | $16.47 | $91.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.73 / $38.93 / $217.68
| Professional | TC | $29.73 | $38.93 | $217.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.15 / $52.69 / $86.94
| Professional | | $42.15 | $52.69 | $86.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.42 / $16.28 / $24.91
| Professional | 26 | $12.42 | $16.28 | $24.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.73 / $37.17 / $59.49
| Professional | TC | $29.73 | $37.17 | $59.49 |