- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.71 / $21.42 / $53.78
| Facility | 26 | $20.71 | $21.42 | $53.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.78 / $64.03 / $92.68
| Professional | | $44.78 | $64.03 | $92.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.32 / $21.64 / $32.84
| Professional | 26 | $16.32 | $21.64 | $32.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.13 / $40.22 / $59.84
| Professional | TC | $28.13 | $40.22 | $59.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.30 / $19.09 / $19.09
| Professional | 26 | $16.30 | $19.09 | $19.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.05 / $70.61 / $106.69
| Professional | | $61.05 | $70.61 | $106.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.34 / $25.39 / $36.65
| Professional | 26 | $21.34 | $25.39 | $36.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.71 / $44.92 / $70.04
| Professional | TC | $39.71 | $44.92 | $70.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.18 / $17.98 / $17.98
| Professional | 26 | $17.18 | $17.98 | $17.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.70 / $69.25 / $106.51
| Professional | | $48.70 | $69.25 | $106.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.85 / $24.47 / $37.46
| Professional | 26 | $17.85 | $24.47 | $37.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.08 / $44.31 / $79.77
| Professional | TC | $32.08 | $44.31 | $79.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.22 / $65.31 / $123.16
| Professional | | $45.22 | $65.31 | $123.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.96 / $21.40 / $34.35
| Professional | 26 | $15.96 | $21.40 | $34.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.58 / $40.59 / $87.72
| Professional | TC | $28.58 | $40.59 | $87.72 |