- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $19.50 / $81.28
| Facility | 26 | $10.96 | $19.50 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $66.07
| Professional | | $32.36 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $12.88 / $33.11
| Professional | 26 | $10.00 | $12.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.18 / $44.67
| Professional | TC | $21.88 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $28.84 / $64.57
| Professional | | $28.18 | $28.84 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $13.49 / $23.99
| Professional | 26 | $10.23 | $13.49 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $40.74 / $56.23
| Professional | | $13.80 | $40.74 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $12.02 / $19.95
| Facility | 26 | $12.02 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $40.74 / $70.79
| Professional | | $31.62 | $40.74 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $13.80 / $23.99
| Professional | 26 | $10.72 | $13.80 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $26.30 / $44.67
| Professional | TC | $19.95 | $26.30 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $100.00 / $100.00
| Facility | 26 | $32.36 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $47.86 / $281.84
| Professional | | $35.48 | $47.86 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $15.14 / $100.00
| Professional | 26 | $12.88 | $15.14 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $29.51 / $251.19
| Professional | TC | $22.39 | $29.51 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $41.69 / $64.57
| Professional | | $33.88 | $41.69 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $14.45 / $21.38
| Professional | 26 | $12.02 | $14.45 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $26.92 / $42.66
| Professional | TC | $21.88 | $26.92 | $42.66 |