- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.04 / $23.04 / $34.56
| Facility | 26 | $23.04 | $23.04 | $34.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.57 / $40.15 / $58.82
| Professional | | $36.57 | $40.15 | $58.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.50 / $23.03 / $27.34
| Professional | 26 | $16.50 | $23.03 | $27.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.33 / $17.17 / $32.36
| Professional | TC | $15.33 | $17.17 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.52 / $59.84 / $70.40
| Professional | | $55.52 | $59.84 | $70.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.53 / $24.53 / $24.53
| Professional | 26 | $24.53 | $24.53 | $24.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.40 / $49.26 / $52.16
| Professional | | $39.40 | $49.26 | $52.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.13 / $25.16 / $26.64
| Professional | 26 | $20.13 | $25.16 | $26.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.28 / $24.10 / $25.52
| Professional | TC | $19.28 | $24.10 | $25.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.02 / $55.70 / $77.97
| Professional | | $39.02 | $55.70 | $77.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.67 / $29.41 / $39.83
| Professional | 26 | $16.67 | $29.41 | $39.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.25 / $23.64 / $43.47
| Professional | TC | $19.25 | $23.64 | $43.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.83 / $68.81 / $80.95
| Professional | | $48.83 | $68.81 | $80.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.21 / $28.21 / $28.21
| Professional | 26 | $28.21 | $28.21 | $28.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.51 / $45.35 / $67.37
| Professional | | $35.51 | $45.35 | $67.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.37 / $24.06 / $35.63
| Professional | 26 | $16.37 | $24.06 | $35.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.16 / $22.41 / $39.40
| Professional | TC | $16.16 | $22.41 | $39.40 |