- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $10.96 / $15.14
| Facility | 26 | $10.00 | $10.96 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $34.67 / $74.13
| Professional | | $22.91 | $34.67 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $9.55 / $18.20
| Professional | 26 | $7.08 | $9.55 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | 52 | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $21.88 / $39.81
| Professional | TC | $15.14 | $21.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $35.48 / $46.77
| Professional | | $30.20 | $35.48 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $12.59 / $16.22
| Professional | 26 | $10.00 | $12.59 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $23.99 / $33.88
| Professional | TC | $20.42 | $23.99 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $9.33 / $39.81
| Professional | 26 | $8.51 | $9.33 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $33.11 / $64.57
| Professional | | $19.50 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $10.72 / $19.50
| Professional | 26 | $6.31 | $10.72 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.18 / $22.91 / $43.65
| Professional | TC | $13.18 | $22.91 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.11 / $53.70
| Professional | | $25.70 | $33.11 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $9.77 / $15.85
| Professional | 26 | $7.76 | $9.77 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $21.88 / $35.48
| Professional | TC | $17.78 | $21.88 | $35.48 |