- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $17.78 / $17.78
| Facility | 26 | $13.80 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $42.66 / $75.86
| Professional | | $33.88 | $42.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.14 / $28.18
| Professional | 26 | $12.02 | $15.14 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $25.12 / $36.31
| Professional | TC | $20.89 | $25.12 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $40.74 / $53.70
| Professional | | $30.90 | $40.74 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $17.38 / $19.95
| Professional | 26 | $11.75 | $17.38 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $43.65 / $52.48
| Professional | | $30.90 | $43.65 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $17.38 / $20.42
| Professional | 26 | $12.02 | $17.38 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $26.92 / $31.62
| Professional | TC | $19.05 | $26.92 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $97.72
| Professional | | $36.31 | $46.77 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $18.62 / $35.48
| Professional | 26 | $14.45 | $18.62 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.18 / $61.66
| Professional | TC | $21.88 | $28.18 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $37.15 / $54.95
| Professional | | $27.54 | $37.15 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $15.14 / $22.39
| Professional | 26 | $10.72 | $15.14 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $22.91 / $33.11
| Professional | TC | $17.38 | $22.91 | $33.11 |