- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.54 / $24.59 / $37.08
| Facility | 26 | $22.54 | $24.59 | $37.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.99 / $35.97 / $71.30
| Professional | | $30.99 | $35.97 | $71.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.30 / $23.76 / $50.06
| Professional | 26 | $20.30 | $23.76 | $50.06 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $15.15 / $17.18 / $21.82
| Professional | 52 | $15.15 | $17.18 | $21.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.18 / $12.09 / $18.39
| Professional | TC | $10.18 | $12.09 | $18.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.25 / $44.75 / $66.70
| Professional | | $31.25 | $44.75 | $66.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.30 / $29.68 / $43.18
| Professional | 26 | $20.30 | $29.68 | $43.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.39 / $15.05 / $23.88
| Professional | TC | $10.39 | $15.05 | $23.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.15 / $25.15 / $25.15
| Facility | 26 | $25.15 | $25.15 | $25.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.86 / $45.59 / $75.08
| Professional | | $33.86 | $45.59 | $75.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.27 / $30.27 / $49.94
| Professional | 26 | $22.27 | $30.27 | $49.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.57 / $15.39 / $25.65
| Professional | TC | $11.57 | $15.39 | $25.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.71 / $39.79 / $66.70
| Professional | | $29.71 | $39.79 | $66.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.27 / $26.59 / $45.45
| Professional | 26 | $20.27 | $26.59 | $45.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.66 / $12.93 / $20.86
| Professional | TC | $9.66 | $12.93 | $20.86 |