- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.73 / $48.13 / $159.99
| Facility | 26 | $42.73 | $48.13 | $159.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.95 / $74.00 / $126.31
| Professional | | $66.95 | $74.00 | $126.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.75 / $46.82 / $66.06
| Professional | 26 | $38.75 | $46.82 | $66.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.57 / $30.53 / $66.39
| Professional | TC | $22.57 | $30.53 | $66.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.17 / $114.17 / $114.17
| Professional | | $114.17 | $114.17 | $114.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.85 / $100.03 / $128.47
| Professional | | $57.85 | $100.03 | $128.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.15 / $51.65 / $79.06
| Professional | 26 | $38.15 | $51.65 | $79.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.53 / $44.80 / $57.60
| Professional | TC | $21.53 | $44.80 | $57.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $50.94 / $50.94
| Professional | 26 | $40.00 | $50.94 | $50.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.59 / $86.23 / $147.63
| Professional | | $66.59 | $86.23 | $147.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.61 / $49.79 / $79.97
| Professional | 26 | $35.61 | $49.79 | $79.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.31 / $38.56 / $64.70
| Professional | TC | $24.31 | $38.56 | $64.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.97 / $64.12 / $111.96
| Professional | | $51.97 | $64.12 | $111.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.87 / $38.76 / $63.00
| Professional | 26 | $29.87 | $38.76 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.57 / $25.12 / $42.74
| Professional | TC | $17.57 | $25.12 | $42.74 |