- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.42 / $24.74 / $34.95
| Facility | 26 | $21.42 | $24.74 | $34.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.59 / $69.38 / $98.61
| Professional | | $42.59 | $69.38 | $98.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.04 / $24.74 / $33.99
| Professional | 26 | $14.04 | $24.74 | $33.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.18 / $43.42 / $64.62
| Professional | TC | $29.18 | $43.42 | $64.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.82 / $19.82 / $22.79
| Professional | 26 | $19.82 | $19.82 | $22.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.62 / $84.48 / $113.14
| Professional | | $74.62 | $84.48 | $113.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.48 / $31.38 / $41.00
| Professional | 26 | $24.48 | $31.38 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.14 / $57.35 / $86.68
| Professional | TC | $50.14 | $57.35 | $86.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.94 / $18.94 / $20.44
| Professional | 26 | $18.94 | $18.94 | $20.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.33 / $67.38 / $115.29
| Professional | | $38.33 | $67.38 | $115.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.92 / $23.33 / $39.54
| Professional | 26 | $12.92 | $23.33 | $39.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.42 / $42.02 / $76.44
| Professional | TC | $25.42 | $42.02 | $76.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.81 / $64.23 / $112.84
| Professional | | $47.81 | $64.23 | $112.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.03 / $22.81 / $37.22
| Professional | 26 | $18.03 | $22.81 | $37.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.56 / $42.27 / $66.40
| Professional | TC | $29.56 | $42.27 | $66.40 |