- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $12.88 / $22.39
| Facility | 26 | $12.88 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $44.67 / $77.62
| Professional | | $34.67 | $44.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $14.13 / $30.20
| Professional | 26 | $10.96 | $14.13 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $30.20 / $54.95
| Professional | TC | $22.91 | $30.20 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $32.36 / $64.57
| Professional | | $28.18 | $32.36 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $14.45 / $31.62
| Professional | 26 | $10.23 | $14.45 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | TC | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $53.70 / $75.86
| Professional | | $30.20 | $53.70 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $19.95 / $26.92
| Professional | 26 | $11.22 | $19.95 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $33.88 / $50.12
| Professional | TC | $20.42 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $32.36 / $33.11
| Professional | | $22.39 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $44.67 / $83.18
| Professional | | $31.62 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $15.14 / $28.18
| Professional | 26 | $10.96 | $15.14 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $28.84 / $54.95
| Professional | TC | $20.42 | $28.84 | $54.95 |