- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.99 / $37.11 / $44.53
| Facility | 26 | $25.99 | $37.11 | $44.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.27 / $63.20 / $113.59
| Professional | | $28.27 | $63.20 | $113.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.04 / $25.99 / $34.50
| Professional | 26 | $16.04 | $25.99 | $34.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.23 / $35.04 / $77.37
| Professional | TC | $12.23 | $35.04 | $77.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.04 / $37.79 / $43.44
| Professional | 26 | $31.04 | $37.79 | $43.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.20 / $67.77 / $75.30
| Professional | | $51.20 | $67.77 | $75.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.49 / $32.40 / $36.01
| Professional | 26 | $24.49 | $32.40 | $36.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.72 / $35.36 / $39.29
| Professional | TC | $26.72 | $35.36 | $39.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.95 / $93.41 / $155.00
| Professional | | $60.95 | $93.41 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.71 / $39.40 / $55.02
| Professional | 26 | $26.71 | $39.40 | $55.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.91 / $55.84 / $78.76
| Professional | TC | $21.91 | $55.84 | $78.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.70 / $43.47 / $49.96
| Professional | 26 | $35.70 | $43.47 | $49.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.52 / $75.72 / $121.67
| Professional | | $43.52 | $75.72 | $121.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.35 / $27.76 / $46.62
| Professional | 26 | $21.35 | $27.76 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.34 / $35.59 / $77.40
| Professional | TC | $20.34 | $35.59 | $77.40 |