- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $51.29 / $61.66
| Facility | 26 | $35.48 | $51.29 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $57.54 / $144.54
| Professional | | $41.69 | $57.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $15.85 / $39.81
| Professional | 26 | $12.02 | $15.85 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $38.90 / $104.71
| Professional | TC | $28.84 | $38.90 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $42.66 / $83.18
| Professional | | $33.88 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $14.13 / $27.54
| Professional | 26 | $11.22 | $14.13 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $28.18 / $54.95
| Professional | TC | $22.39 | $28.18 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $67.61 / $117.49
| Professional | | $46.77 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $20.42 / $36.31
| Professional | 26 | $14.45 | $20.42 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $48.98 / $81.28
| Professional | TC | $31.62 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $33.11 / $79.43
| Facility | 26 | $33.11 | $33.11 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $67.61 / $537.03
| Professional | | $45.71 | $67.61 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $19.05 / $91.20
| Professional | 26 | $13.49 | $19.05 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $47.86 / $218.78
| Professional | TC | $32.36 | $47.86 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $56.23 / $102.33
| Professional | | $43.65 | $56.23 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $16.60 / $30.20
| Professional | 26 | $13.18 | $16.60 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $40.74 / $70.79
| Professional | TC | $30.90 | $40.74 | $70.79 |