- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $22.39 / $33.88
| Facility | 26 | $21.88 | $22.39 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $47.86 / $83.18
| Professional | | $34.67 | $47.86 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $19.95 / $28.84
| Professional | 26 | $15.14 | $19.95 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $23.99 / $47.86
| Professional | TC | $19.05 | $23.99 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $57.54 / $114.82
| Professional | | $37.15 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $23.99 / $46.77
| Professional | 26 | $17.38 | $23.99 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $56.23 / $85.11 / $162.18
| Professional | 50 | $56.23 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $33.11 / $70.79
| Professional | TC | $20.89 | $33.11 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.01 / $26.30 / $52.48
| Facility | 26 | $5.01 | $26.30 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $63.10 / $128.82
| Professional | | $36.31 | $63.10 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $26.30 / $54.95
| Professional | 26 | $16.60 | $26.30 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $36.31 / $74.13
| Professional | TC | $19.95 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $50.12 / $87.10
| Professional | | $34.67 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $21.38 / $35.48
| Professional | 26 | $15.14 | $21.38 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $28.18 / $51.29
| Professional | TC | $19.50 | $28.18 | $51.29 |