- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.89 / $19.89 / $19.89
| Facility | 26 | $19.89 | $19.89 | $19.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.74 / $53.31 / $77.56
| Professional | | $44.74 | $53.31 | $77.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.44 / $14.36 / $20.28
| Professional | 26 | $11.44 | $14.36 | $20.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.29 / $39.53 / $57.68
| Professional | TC | $33.29 | $39.53 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.36 / $63.19 / $63.19
| Professional | | $40.36 | $63.19 | $63.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.02 / $11.07 / $16.60
| Professional | 26 | $11.02 | $11.07 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.99 / $57.52 / $67.87
| Professional | | $41.99 | $57.52 | $67.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.45 / $15.68 / $18.50
| Professional | 26 | $11.45 | $15.68 | $18.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.54 / $41.84 / $49.37
| Professional | TC | $30.54 | $41.84 | $49.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.65 / $63.98 / $139.43
| Professional | | $42.65 | $63.98 | $139.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.12 / $20.28 / $36.94
| Professional | 26 | $12.12 | $20.28 | $36.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.90 / $46.26 / $110.58
| Professional | TC | $34.90 | $46.26 | $110.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.55 / $55.46 / $76.84
| Professional | | $43.55 | $55.46 | $76.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.37 / $15.61 / $22.23
| Professional | 26 | $12.37 | $15.61 | $22.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.39 / $39.54 / $53.63
| Professional | TC | $30.39 | $39.54 | $53.63 |