- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $19.95 / $53.70
| Facility | 26 | $12.02 | $19.95 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $48.98 / $141.25
| Professional | | $36.31 | $48.98 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $15.14 / $42.66
| Professional | 26 | $10.47 | $15.14 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $33.88 / $70.79
| Professional | TC | $23.99 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Facility | 26 | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $52.48 / $97.72
| Professional | | $38.02 | $52.48 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $17.78 / $30.20
| Professional | 26 | $12.88 | $17.78 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $35.48 / $69.18
| Professional | TC | $25.70 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.24 / $17.38 / $42.66
| Facility | 26 | $3.24 | $17.38 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $61.66 / $120.23
| Professional | | $37.15 | $61.66 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $18.62 / $36.31
| Professional | 26 | $10.96 | $18.62 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $42.66 / $91.20
| Professional | TC | $25.70 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $47.86 / $91.20
| Professional | | $36.31 | $47.86 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $14.79 / $28.18
| Professional | 26 | $11.22 | $14.79 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $33.11 / $64.57
| Professional | TC | $25.12 | $33.11 | $64.57 |