- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $20.42 / $52.48
| Facility | 26 | $13.49 | $20.42 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $56.23 / $151.36
| Professional | | $39.81 | $56.23 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $21.38 / $48.98
| Professional | 26 | $12.88 | $21.38 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $36.31 / $75.86
| Professional | TC | $25.70 | $36.31 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $54.95 / $104.71
| Professional | | $33.88 | $54.95 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $20.42 / $35.48
| Professional | 26 | $10.47 | $20.42 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $36.31 / $70.79
| Professional | TC | $23.99 | $36.31 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.80 / $19.95 / $47.86
| Facility | 26 | $3.80 | $19.95 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $64.57 / $125.89
| Professional | | $38.90 | $64.57 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $21.38 / $41.69
| Professional | 26 | $12.59 | $21.38 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $43.65 / $91.20
| Professional | TC | $26.30 | $43.65 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $50.12 / $95.50
| Professional | | $38.02 | $50.12 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $16.60 / $31.62
| Professional | 26 | $12.88 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $33.88 / $64.57
| Professional | TC | $25.12 | $33.88 | $64.57 |