- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.46 / $13.11 / $23.41
| Facility | 26 | $10.46 | $13.11 | $23.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.40 / $62.60 / $172.55
| Professional | | $37.40 | $62.60 | $172.55 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $90.40 / $90.40 / $90.40
| Professional | 25 | $90.40 | $90.40 | $90.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.68 / $13.71 / $40.11
| Professional | 26 | $9.68 | $13.71 | $40.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.99 / $45.65 / $69.12
| Professional | TC | $26.99 | $45.65 | $69.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.52 / $59.24 / $99.02
| Professional | | $40.52 | $59.24 | $99.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.46 / $15.83 / $24.51
| Professional | 26 | $10.46 | $15.83 | $24.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.10 / $44.30 / $73.24
| Professional | TC | $30.10 | $44.30 | $73.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.60 / $11.60 / $11.60
| Facility | 26 | $11.60 | $11.60 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.16 / $70.98 / $117.60
| Professional | | $43.16 | $70.98 | $117.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.05 / $17.27 / $28.45
| Professional | 26 | $11.05 | $17.27 | $28.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.82 / $52.87 / $91.18
| Professional | TC | $32.82 | $52.87 | $91.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.42 / $65.11 / $108.49
| Professional | | $49.42 | $65.11 | $108.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.41 / $15.50 / $26.02
| Professional | 26 | $11.41 | $15.50 | $26.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.54 / $51.07 / $83.79
| Professional | TC | $37.54 | $51.07 | $83.79 |