- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $35.48 / $95.50
| Facility | 26 | $20.89 | $35.48 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $74.13 / $263.03
| Professional | | $38.90 | $74.13 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $40.74 / $123.03
| Professional | 26 | $19.95 | $40.74 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $22.91 / $61.66
| Professional | TC | $16.98 | $22.91 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Facility | 26 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $60.26 / $128.82
| Professional | | $41.69 | $60.26 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $31.62 / $53.70
| Professional | 26 | $21.88 | $31.62 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $28.84 / $83.18
| Professional | TC | $18.62 | $28.84 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.75 / $30.90 / $75.86
| Facility | 26 | $5.75 | $30.90 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $67.61 / $131.83
| Professional | | $38.02 | $67.61 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $33.11 / $64.57
| Professional | 26 | $19.95 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $32.36 / $74.13
| Professional | TC | $17.78 | $32.36 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $53.70 / $104.71
| Professional | | $38.02 | $53.70 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $26.92 / $48.98
| Professional | 26 | $19.95 | $26.92 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $25.70 / $58.88
| Professional | TC | $17.78 | $25.70 | $58.88 |