- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $36.31 / $95.50
| Facility | 26 | $23.99 | $36.31 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $89.13 / $346.74
| Professional | | $47.86 | $89.13 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $38.02 / $104.71
| Professional | 26 | $23.99 | $38.02 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $38.90 / $104.71
| Professional | TC | $22.91 | $38.90 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | 26 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $95.50 / $173.78
| Professional | | $54.95 | $95.50 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $37.15 / $61.66
| Professional | 26 | $26.92 | $37.15 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $57.54 / $112.20
| Professional | TC | $30.20 | $57.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $35.48 / $87.10
| Facility | 26 | $6.76 | $35.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $97.72 / $181.97
| Professional | | $50.12 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $38.02 / $72.44
| Professional | 26 | $22.91 | $38.02 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $54.95 / $114.82
| Professional | TC | $26.30 | $54.95 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $77.62 / $144.54
| Professional | | $51.29 | $77.62 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $30.90 / $56.23
| Professional | 26 | $22.91 | $30.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $42.66 / $91.20
| Professional | TC | $25.70 | $42.66 | $91.20 |