- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $17.38 / $44.67
| Facility | 26 | $10.96 | $17.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $52.48 / $151.36
| Professional | | $36.31 | $52.48 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.60 / $40.74
| Professional | 26 | $10.00 | $16.60 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $34.67 / $83.18
| Professional | TC | $25.12 | $34.67 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | 26 | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $51.29 / $95.50
| Professional | | $37.15 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $16.60 / $28.18
| Professional | 26 | $12.02 | $16.60 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $35.48 / $69.18
| Professional | TC | $25.70 | $35.48 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $16.22 / $38.90
| Facility | 26 | $3.02 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $58.88 / $120.23
| Professional | | $36.31 | $58.88 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $17.38 / $33.88
| Professional | 26 | $10.23 | $17.38 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $42.66 / $91.20
| Professional | TC | $25.70 | $42.66 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $46.77 / $91.20
| Professional | | $36.31 | $46.77 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $13.80 / $26.30
| Professional | 26 | $10.47 | $13.80 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $33.11 / $64.57
| Professional | TC | $25.12 | $33.11 | $64.57 |