- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $34.67 / $43.72
| Facility | 26 | $34.67 | $34.67 | $43.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.63 / $58.98 / $110.09
| Professional | | $33.63 | $58.98 | $110.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.59 / $39.25 / $69.45
| Professional | 26 | $21.59 | $39.25 | $69.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.04 / $19.73 / $42.92
| Professional | TC | $12.04 | $19.73 | $42.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.04 / $32.04 / $35.94
| Professional | 26 | $32.04 | $32.04 | $35.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.23 / $30.23 / $30.23
| Professional | TC | $30.23 | $30.23 | $30.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.29 / $67.03 / $83.18
| Professional | | $59.29 | $67.03 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.69 / $41.64 / $55.34
| Professional | 26 | $35.69 | $41.64 | $55.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.70 / $24.22 / $29.60
| Professional | TC | $15.70 | $24.22 | $29.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.28 / $31.28 / $31.28
| Professional | 26 | $31.28 | $31.28 | $31.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.44 / $31.23 / $112.83
| Professional | | $25.44 | $31.23 | $112.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.02 / $21.00 / $68.95
| Professional | 26 | $16.02 | $21.00 | $68.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.18 / $10.23 / $38.15
| Professional | TC | $9.18 | $10.23 | $38.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.04 / $57.02 / $104.12
| Professional | | $32.04 | $57.02 | $104.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.37 / $37.53 / $69.28
| Professional | 26 | $20.37 | $37.53 | $69.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.65 / $19.85 / $34.84
| Professional | TC | $10.65 | $19.85 | $34.84 |