- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $38.02 / $41.69
| Facility | 26 | $25.70 | $38.02 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $61.66 / $208.93
| Professional | | $33.11 | $61.66 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $25.12 / $60.26
| Professional | 26 | $19.95 | $25.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.02 / $23.99 / $53.70
| Professional | TC | $12.02 | $23.99 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $22.91 / $26.30
| Professional | 26 | $19.05 | $22.91 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $58.88 / $77.62
| Professional | | $45.71 | $58.88 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $34.67 / $40.74
| Professional | 26 | $27.54 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $22.39 / $47.86
| Professional | TC | $17.78 | $22.39 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $23.99 / $39.81
| Professional | 26 | $23.99 | $23.99 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $51.29 / $109.65
| Professional | | $28.84 | $51.29 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $28.84 / $44.67
| Professional | 26 | $16.98 | $28.84 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $26.92 / $69.18
| Professional | TC | $11.75 | $26.92 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $61.66 / $102.33
| Professional | | $41.69 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $25.12 / $41.69
| Professional | 26 | $20.89 | $25.12 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $36.31 / $64.57
| Professional | TC | $18.62 | $36.31 | $64.57 |