- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.96 / $31.96 / $31.96
| Facility | 26 | $31.96 | $31.96 | $31.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.57 / $68.20 / $93.21
| Professional | | $43.57 | $68.20 | $93.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.12 / $20.72 / $33.54
| Professional | 26 | $16.12 | $20.72 | $33.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.44 / $47.72 / $59.66
| Professional | TC | $27.44 | $47.72 | $59.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $37.04 / $37.04
| Professional | | $37.04 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.71 / $19.34 / $21.37
| Professional | 26 | $13.71 | $19.34 | $21.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $79.50 / $93.81
| Professional | | $55.65 | $79.50 | $93.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $19.54 / $23.06
| Professional | 26 | $14.26 | $19.54 | $23.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.97 / $59.96 / $70.75
| Professional | TC | $41.97 | $59.96 | $70.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.99 / $75.20 / $142.88
| Professional | | $39.99 | $75.20 | $142.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.00 / $25.44 / $50.67
| Professional | 26 | $17.00 | $25.44 | $50.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.94 / $51.09 / $105.88
| Professional | TC | $30.94 | $51.09 | $105.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.88 / $52.87 / $104.80
| Professional | | $40.88 | $52.87 | $104.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.08 / $18.14 / $27.30
| Professional | 26 | $14.08 | $18.14 | $27.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.95 / $32.15 / $76.47
| Professional | TC | $25.95 | $32.15 | $76.47 |