- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.75 / $30.15 / $46.24
| Facility | 26 | $25.75 | $30.15 | $46.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.65 / $55.31 / $119.96
| Professional | | $54.65 | $55.31 | $119.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.88 / $26.06 / $56.39
| Professional | 26 | $24.88 | $26.06 | $56.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.91 / $29.25 / $63.57
| Professional | TC | $28.91 | $29.25 | $63.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.51 / $61.95 / $86.34
| Professional | | $32.51 | $61.95 | $86.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.00 / $74.95 / $108.31
| Professional | | $52.00 | $74.95 | $108.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.45 / $43.31 / $60.53
| Professional | 26 | $30.45 | $43.31 | $60.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.30 / $33.25 / $51.00
| Professional | TC | $18.30 | $33.25 | $51.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.78 / $72.78 / $145.80
| Facility | 26 | $72.78 | $72.78 | $145.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.43 / $65.00 / $141.15
| Professional | | $49.43 | $65.00 | $141.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.56 / $34.86 / $196.52
| Professional | 26 | $27.56 | $34.86 | $196.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.88 / $26.39 / $244.63
| Professional | TC | $16.88 | $26.39 | $244.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.83 / $60.21 / $89.89
| Professional | | $46.83 | $60.21 | $89.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.76 / $34.63 / $53.00
| Professional | 26 | $26.76 | $34.63 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.62 / $25.98 / $47.05
| Professional | TC | $16.62 | $25.98 | $47.05 |