- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.60 / $43.65
| Facility | 26 | $10.96 | $16.60 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $45.71 / $144.54
| Professional | | $21.88 | $45.71 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $17.78 / $43.65
| Professional | 26 | $10.96 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $34.67 / $75.86
| Professional | TC | $22.39 | $34.67 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $14.45 / $14.45
| Facility | 26 | $14.45 | $14.45 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $46.77 / $87.10
| Professional | | $34.67 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.98 / $28.84
| Professional | 26 | $10.96 | $16.98 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $30.20 / $58.88
| Professional | TC | $22.39 | $30.20 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.09 / $16.60 / $40.74
| Facility | 26 | $3.09 | $16.60 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $53.70 / $109.65
| Professional | | $32.36 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $17.78 / $34.67
| Professional | 26 | $10.47 | $17.78 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $36.31 / $77.62
| Professional | TC | $21.88 | $36.31 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $81.28
| Professional | | $32.36 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $14.13 / $26.92
| Professional | 26 | $10.72 | $14.13 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $28.18 / $54.95
| Professional | TC | $21.38 | $28.18 | $54.95 |