- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.71 / $24.99 / $30.46
| Facility | 26 | $22.71 | $24.99 | $30.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.07 / $73.73 / $100.15
| Professional | | $44.07 | $73.73 | $100.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.01 / $23.05 / $50.30
| Professional | 26 | $18.01 | $23.05 | $50.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.16 / $30.92 / $69.69
| Professional | TC | $21.16 | $30.92 | $69.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.59 / $50.56 / $103.20
| Professional | | $23.59 | $50.56 | $103.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.65 / $26.65 / $26.65
| Facility | 26 | $26.65 | $26.65 | $26.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.58 / $69.00 / $159.25
| Professional | | $40.58 | $69.00 | $159.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.13 / $30.25 / $73.43
| Professional | 26 | $19.13 | $30.25 | $73.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.72 / $34.81 / $131.38
| Professional | TC | $20.72 | $34.81 | $131.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.34 / $90.79 / $131.16
| Professional | | $78.34 | $90.79 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.57 / $39.28 / $62.44
| Professional | 26 | $36.57 | $39.28 | $62.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.22 / $46.36 / $48.78
| Professional | TC | $42.22 | $46.36 | $48.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.84 / $82.63 / $160.38
| Professional | | $40.84 | $82.63 | $160.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.71 / $23.28 / $38.24
| Professional | 26 | $14.71 | $23.28 | $38.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.78 / $61.07 / $131.11
| Professional | TC | $18.78 | $61.07 | $131.11 |