- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.97 / $16.85 / $32.97
| Facility | 26 | $13.97 | $16.85 | $32.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.95 / $53.76 / $96.43
| Professional | | $43.95 | $53.76 | $96.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.37 / $14.06 / $23.56
| Professional | 26 | $12.37 | $14.06 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.22 / $37.71 / $69.03
| Professional | TC | $31.22 | $37.71 | $69.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.42 / $16.42 / $16.42
| Facility | 26 | $16.42 | $16.42 | $16.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.31 / $62.10 / $107.89
| Professional | | $51.31 | $62.10 | $107.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.26 / $17.45 / $29.99
| Professional | 26 | $13.26 | $17.45 | $29.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.40 / $45.98 / $78.81
| Professional | TC | $36.40 | $45.98 | $78.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.20 / $16.20 / $16.20
| Facility | 26 | $16.20 | $16.20 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.97 / $72.05 / $118.69
| Professional | | $47.97 | $72.05 | $118.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.78 / $20.49 / $33.13
| Professional | 26 | $12.78 | $20.49 | $33.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.75 / $53.11 / $86.23
| Professional | TC | $35.75 | $53.11 | $86.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.25 / $59.71 / $113.32
| Professional | | $42.25 | $59.71 | $113.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.84 / $17.32 / $32.29
| Professional | 26 | $11.84 | $17.32 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.28 / $43.43 / $83.68
| Professional | TC | $30.28 | $43.43 | $83.68 |