- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.78 / $18.98 / $34.57
| Facility | 26 | $14.78 | $18.98 | $34.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.79 / $53.00 / $106.15
| Professional | | $43.79 | $53.00 | $106.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.29 / $15.61 / $34.57
| Professional | 26 | $13.29 | $15.61 | $34.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.92 / $38.60 / $69.81
| Professional | TC | $30.92 | $38.60 | $69.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.51 / $17.51 / $17.51
| Facility | 26 | $17.51 | $17.51 | $17.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.86 / $59.55 / $101.13
| Professional | | $46.86 | $59.55 | $101.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.88 / $20.79 / $31.11
| Professional | 26 | $14.88 | $20.79 | $31.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.95 / $41.81 / $70.32
| Professional | TC | $31.95 | $41.81 | $70.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.71 / $17.71 / $17.71
| Facility | 26 | $17.71 | $17.71 | $17.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.53 / $68.17 / $110.90
| Professional | | $46.53 | $68.17 | $110.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.94 / $21.94 / $35.35
| Professional | 26 | $13.94 | $21.94 | $35.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.95 / $47.27 / $78.94
| Professional | TC | $31.95 | $47.27 | $78.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $57.17 / $99.59
| Professional | | $46.77 | $57.17 | $99.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.69 / $18.60 / $32.39
| Professional | 26 | $14.69 | $18.60 | $32.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.54 / $39.72 / $67.20
| Professional | TC | $31.54 | $39.72 | $67.20 |