- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $26.92 / $34.67
| Facility | 26 | $23.99 | $26.92 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $66.07 / $97.72
| Professional | | $50.12 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $20.89 / $48.98
| Professional | 26 | $16.98 | $20.89 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.11 / $42.66 / $64.57
| Professional | TC | $33.11 | $42.66 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $19.50 / $20.42
| Professional | 26 | $19.50 | $19.50 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $79.43 / $100.00
| Professional | | $67.61 | $79.43 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $28.18 / $36.31
| Professional | 26 | $22.91 | $28.18 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $53.70 / $63.10
| Professional | TC | $44.67 | $53.70 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $20.42 / $39.81
| Professional | 26 | $19.50 | $20.42 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $125.89
| Professional | | $41.69 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $23.44 / $42.66
| Professional | 26 | $14.13 | $23.44 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $45.71 / $85.11
| Professional | TC | $27.54 | $45.71 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $64.57 / $100.00
| Professional | | $47.86 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $22.39 / $34.67
| Professional | 26 | $18.20 | $22.39 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $41.69 / $64.57
| Professional | TC | $29.51 | $41.69 | $64.57 |