- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $19.05 / $25.70
| Facility | 26 | $16.98 | $19.05 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $42.66 / $81.28
| Professional | | $28.84 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.85 / $36.31
| Professional | 26 | $12.02 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $25.70 / $46.77
| Professional | TC | $16.98 | $25.70 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $39.81
| Professional | | $33.88 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.95 / $11.48 / $21.88
| Professional | 26 | $2.95 | $11.48 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $64.57
| Professional | | $43.65 | $51.29 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $19.95 / $26.30
| Professional | 26 | $16.60 | $19.95 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $31.62 / $37.15
| Professional | TC | $26.92 | $31.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $15.14
| Professional | 26 | $14.13 | $14.13 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $87.10
| Professional | | $26.30 | $43.65 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.98 / $30.20
| Professional | 26 | $10.00 | $16.98 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.49 / $28.18 / $54.95
| Professional | TC | $15.49 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $44.67 / $81.28
| Professional | | $30.90 | $44.67 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $16.22 / $24.55
| Professional | 26 | $12.59 | $16.22 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.38 / $26.92 / $53.70
| Professional | TC | $17.38 | $26.92 | $53.70 |