- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.95 / $35.45 / $40.02
| Facility | 26 | $32.95 | $35.45 | $40.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.34 / $67.20 / $106.10
| Professional | | $57.34 | $67.20 | $106.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.96 / $32.47 / $48.11
| Professional | 26 | $25.96 | $32.47 | $48.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.03 / $34.64 / $58.74
| Professional | TC | $31.03 | $34.64 | $58.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.00 / $73.00 / $85.28
| Professional | | $73.00 | $73.00 | $85.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.42 / $29.79 / $33.79
| Professional | 26 | $24.42 | $29.79 | $33.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.06 / $71.41 / $98.46
| Professional | | $59.06 | $71.41 | $98.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.99 / $32.59 / $47.73
| Professional | 26 | $28.99 | $32.59 | $47.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.03 / $39.11 / $49.92
| Professional | TC | $31.03 | $39.11 | $49.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.55 / $28.36 / $40.00
| Professional | 26 | $25.55 | $28.36 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.36 / $31.36 / $31.36
| Facility | 26 | $31.36 | $31.36 | $31.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.57 / $74.59 / $150.09
| Professional | | $59.57 | $74.59 | $150.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.00 / $35.64 / $57.83
| Professional | 26 | $28.00 | $35.64 | $57.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.45 / $40.00 / $80.12
| Professional | TC | $31.45 | $40.00 | $80.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.22 / $60.27 / $105.75
| Professional | | $48.22 | $60.27 | $105.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.39 / $29.23 / $48.66
| Professional | 26 | $23.39 | $29.23 | $48.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.30 / $30.63 / $52.40
| Professional | TC | $24.30 | $30.63 | $52.40 |