- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.94 / $37.18 / $48.58
| Facility | 26 | $29.94 | $37.18 | $48.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.54 / $59.53 / $91.54
| Professional | | $44.54 | $59.53 | $91.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.10 / $33.45 / $50.50
| Professional | 26 | $24.10 | $33.45 | $50.50 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $19.47 / $55.06 / $231.00
| Professional | 52 | $19.47 | $55.06 | $231.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.77 / $26.19 / $41.71
| Professional | TC | $19.77 | $26.19 | $41.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.08 / $47.15 / $53.49
| Professional | | $14.08 | $47.15 | $53.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.22 / $26.63 / $52.73
| Professional | 26 | $26.22 | $26.63 | $52.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.97 / $53.72 / $62.68
| Professional | | $21.97 | $53.72 | $62.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.52 / $30.31 / $35.36
| Professional | 26 | $12.52 | $30.31 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.44 / $23.41 / $27.31
| Professional | TC | $9.44 | $23.41 | $27.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.97 / $27.40 / $29.92
| Professional | 26 | $25.97 | $27.40 | $29.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.35 / $55.80 / $94.30
| Professional | | $31.35 | $55.80 | $94.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.71 / $31.16 / $54.04
| Professional | 26 | $17.71 | $31.16 | $54.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.64 / $23.28 / $41.04
| Professional | TC | $13.64 | $23.28 | $41.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.85 / $58.02 / $97.58
| Professional | | $41.85 | $58.02 | $97.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.81 / $31.35 / $54.19
| Professional | 26 | $23.81 | $31.35 | $54.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.04 / $25.26 / $38.31
| Professional | TC | $18.04 | $25.26 | $38.31 |