- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.78 / $12.33 / $31.68
| Facility | 26 | $11.78 | $12.33 | $31.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.81 / $121.68 / $252.90
| Professional | | $81.81 | $121.68 | $252.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.55 / $12.84 / $16.28
| Professional | 26 | $11.55 | $12.84 | $16.28 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $38.83 / $42.74 / $57.79
| Professional | 52 | $38.83 | $42.74 | $57.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.05 / $108.84 / $122.77
| Professional | TC | $70.05 | $108.84 | $122.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.31 / $121.76 / $151.09
| Professional | | $72.31 | $121.76 | $151.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.14 / $14.14 / $21.79
| Professional | 26 | $10.14 | $14.14 | $21.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.84 / $111.84 / $134.50
| Professional | TC | $65.84 | $111.84 | $134.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $115.14 / $115.14
| Professional | | $115.14 | $115.14 | $115.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.79 / $11.88 / $11.97
| Professional | 26 | $11.79 | $11.88 | $11.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.62 / $137.88 / $214.92
| Professional | | $82.62 | $137.88 | $214.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.06 / $14.42 / $28.89
| Professional | 26 | $10.06 | $14.42 | $28.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.87 / $112.75 / $182.96
| Professional | TC | $69.87 | $112.75 | $182.96 |