- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $17.78 / $23.44
| Facility | 26 | $15.49 | $17.78 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $41.69 / $102.33
| Professional | | $33.88 | $41.69 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.98 / $40.74
| Professional | 26 | $10.96 | $16.98 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $28.18 / $52.48
| Professional | TC | $22.39 | $28.18 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $32.36 / $38.90
| Professional | | $28.18 | $32.36 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $14.45 / $25.12
| Professional | 26 | $10.23 | $14.45 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $19.95 / $26.30
| Professional | TC | $19.95 | $19.95 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $44.67 / $74.13
| Professional | | $39.81 | $44.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $17.78 / $27.54
| Professional | 26 | $14.13 | $17.78 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $26.92 / $48.98
| Professional | TC | $25.12 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $54.95 / $97.72
| Professional | | $34.67 | $54.95 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $17.78 / $30.20
| Professional | 26 | $11.75 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $37.15 / $64.57
| Professional | TC | $24.55 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $43.65 / $72.44
| Professional | | $35.48 | $43.65 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $15.14 / $23.99
| Professional | 26 | $12.59 | $15.14 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $28.84 / $48.98
| Professional | TC | $23.44 | $28.84 | $48.98 |