- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.00 / $16.80 / $28.28
| Facility | 26 | $13.00 | $16.80 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $46.47 / $85.17
| Professional | | $38.86 | $46.47 | $85.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.53 / $13.48 / $26.55
| Professional | 26 | $11.53 | $13.48 | $26.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.23 / $32.00 / $59.42
| Professional | TC | $27.23 | $32.00 | $59.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.71 / $14.71 / $14.71
| Facility | 26 | $14.71 | $14.71 | $14.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.77 / $53.76 / $88.87
| Professional | | $40.77 | $53.76 | $88.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.04 / $18.20 / $27.05
| Professional | 26 | $13.04 | $18.20 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.15 / $38.68 / $61.83
| Professional | TC | $27.15 | $38.68 | $61.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.41 / $15.41 / $15.41
| Facility | 26 | $15.41 | $15.41 | $15.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.68 / $60.19 / $99.57
| Professional | | $40.68 | $60.19 | $99.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.17 / $19.23 / $31.00
| Professional | 26 | $12.17 | $19.23 | $31.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.11 / $40.61 / $71.89
| Professional | TC | $28.11 | $40.61 | $71.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.79 / $52.08 / $89.08
| Professional | | $41.79 | $52.08 | $89.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.99 / $16.27 / $28.78
| Professional | 26 | $12.99 | $16.27 | $28.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.31 / $36.11 / $62.39
| Professional | TC | $28.31 | $36.11 | $62.39 |