- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.00 / $15.50 / $25.87
| Facility | 26 | $12.00 | $15.50 | $25.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.54 / $45.72 / $93.09
| Professional | | $38.54 | $45.72 | $93.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.75 / $12.54 / $27.58
| Professional | 26 | $10.75 | $12.54 | $27.58 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.55 / $31.99 / $61.04
| Professional | TC | $27.55 | $31.99 | $61.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.99 / $13.99 / $13.99
| Facility | 26 | $13.99 | $13.99 | $13.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.69 / $53.01 / $86.80
| Professional | | $39.69 | $53.01 | $86.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.11 / $16.89 / $25.02
| Professional | 26 | $12.11 | $16.89 | $25.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.15 / $38.29 / $62.23
| Professional | TC | $27.15 | $38.29 | $62.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.26 / $14.26 / $14.26
| Facility | 26 | $14.26 | $14.26 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.01 / $57.90 / $98.12
| Professional | | $40.01 | $57.90 | $98.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.25 / $17.78 / $29.02
| Professional | 26 | $11.25 | $17.78 | $29.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.75 / $40.36 / $71.89
| Professional | TC | $27.75 | $40.36 | $71.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.88 / $51.01 / $88.46
| Professional | | $40.88 | $51.01 | $88.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.97 / $15.58 / $26.84
| Professional | 26 | $11.97 | $15.58 | $26.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.92 / $35.18 / $61.57
| Professional | TC | $27.92 | $35.18 | $61.57 |