- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.99 / $27.13 / $27.13
| Facility | 26 | $26.99 | $27.13 | $27.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.09 / $30.10 / $50.32
| Professional | | $25.09 | $30.10 | $50.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.85 / $23.88 / $32.32
| Professional | 26 | $17.85 | $23.88 | $32.32 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $12.55 / $14.97 / $22.95
| Professional | 52 | $12.55 | $14.97 | $22.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.29 / $4.45 / $29.78
| Professional | TC | $3.29 | $4.45 | $29.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.07 / $36.03 / $65.59
| Professional | | $26.07 | $36.03 | $65.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.44 / $25.55 / $38.99
| Professional | 26 | $19.44 | $25.55 | $38.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.60 / $6.52 / $26.88
| Professional | TC | $3.60 | $6.52 | $26.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.95 / $27.95 / $27.95
| Facility | 26 | $27.95 | $27.95 | $27.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.65 / $41.98 / $76.41
| Professional | | $24.65 | $41.98 | $76.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.47 / $27.09 / $50.30
| Professional | 26 | $19.47 | $27.09 | $50.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.04 / $6.16 / $41.40
| Professional | TC | $3.04 | $6.16 | $41.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $37.25 / $66.59
| Professional | | $24.26 | $37.25 | $66.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.55 / $24.25 / $44.77
| Professional | 26 | $16.55 | $24.25 | $44.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $3.42 / $5.41 / $37.49
| Professional | TC | $3.42 | $5.41 | $37.49 |