- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $21.38 / $56.23
| Facility | 26 | $13.49 | $21.38 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $58.88 / $208.93
| Professional | | $39.81 | $58.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $21.38 / $51.29
| Professional | 26 | $12.88 | $21.38 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $38.90 / $83.18
| Professional | TC | $27.54 | $38.90 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $17.38 / $17.38
| Facility | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $109.65
| Professional | | $43.65 | $60.26 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $20.42 / $34.67
| Professional | 26 | $12.88 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $40.74 / $75.86
| Professional | TC | $30.90 | $40.74 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.80 / $19.95 / $48.98
| Facility | 26 | $3.80 | $19.95 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $69.18 / $134.90
| Professional | | $41.69 | $69.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $21.38 / $41.69
| Professional | 26 | $12.88 | $21.38 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $47.86 / $100.00
| Professional | TC | $28.84 | $47.86 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $54.95 / $102.33
| Professional | | $41.69 | $54.95 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $16.98 / $32.36
| Professional | 26 | $12.88 | $16.98 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $37.15 / $70.79
| Professional | TC | $28.18 | $37.15 | $70.79 |