- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.64 / $17.64 / $23.82
| Facility | 26 | $17.64 | $17.64 | $23.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.00 / $39.47 / $47.97
| Professional | | $34.00 | $39.47 | $47.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.00 / $14.81 / $18.53
| Professional | 26 | $13.00 | $14.81 | $18.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.12 / $25.00 / $28.92
| Professional | TC | $21.12 | $25.00 | $28.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.95 / $38.29 / $45.06
| Professional | | $30.95 | $38.29 | $45.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.39 / $14.33 / $16.01
| Professional | 26 | $13.39 | $14.33 | $16.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.11 / $44.00 / $51.92
| Professional | | $32.11 | $44.00 | $51.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.57 / $17.22 / $20.32
| Professional | 26 | $12.57 | $17.22 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.55 / $26.78 / $31.60
| Professional | TC | $19.55 | $26.78 | $31.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.86 / $50.43 / $103.21
| Professional | | $36.86 | $50.43 | $103.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.56 / $20.57 / $37.14
| Professional | 26 | $14.56 | $20.57 | $37.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.05 / $29.64 / $66.08
| Professional | TC | $22.05 | $29.64 | $66.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.79 / $36.40 / $50.23
| Professional | | $27.79 | $36.40 | $50.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.61 / $14.65 / $19.71
| Professional | 26 | $10.61 | $14.65 | $19.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.18 / $22.01 / $30.68
| Professional | TC | $17.18 | $22.01 | $30.68 |