- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $17.78 / $46.77
| Facility | 26 | $10.00 | $17.78 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $54.95 / $181.97
| Professional | | $38.90 | $54.95 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $12.30 / $33.11
| Professional | 26 | $8.91 | $12.30 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $41.69 / $85.11
| Professional | TC | $30.20 | $41.69 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $13.18 / $13.18
| Facility | 26 | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $56.23 / $104.71
| Professional | | $41.69 | $56.23 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $15.49 / $26.30
| Professional | 26 | $11.22 | $15.49 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $41.69 / $81.28
| Professional | TC | $28.84 | $41.69 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.82 / $14.79 / $36.31
| Facility | 26 | $2.82 | $14.79 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $66.07 / $134.90
| Professional | | $40.74 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $16.22 / $32.36
| Professional | 26 | $9.55 | $16.22 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $50.12 / $109.65
| Professional | TC | $30.90 | $50.12 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $52.48 / $102.33
| Professional | | $39.81 | $52.48 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $12.88 / $24.55
| Professional | 26 | $9.77 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $39.81 / $77.62
| Professional | TC | $29.51 | $39.81 | $77.62 |