- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $17.38 / $37.15
| Facility | 26 | $14.45 | $17.38 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $57.54 / $208.93
| Professional | | $42.66 | $57.54 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $20.42 / $47.86
| Professional | 26 | $12.88 | $20.42 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $37.15 / $93.33
| Professional | TC | $30.20 | $37.15 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $56.23 / $93.33
| Professional | | $36.31 | $56.23 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $17.38 / $27.54
| Professional | 26 | $10.47 | $17.38 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $39.81 / $66.07
| Professional | TC | $25.70 | $39.81 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $14.45 / $19.50
| Professional | 26 | $14.45 | $14.45 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $56.23 / $114.82
| Professional | | $41.69 | $56.23 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $16.60 / $31.62
| Professional | 26 | $12.02 | $16.60 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $38.90 / $77.62
| Professional | TC | $28.84 | $38.90 | $77.62 |