- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $17.78 / $43.65
| Facility | 26 | $11.75 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $74.13 / $213.80
| Professional | | $44.67 | $74.13 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $20.89 / $52.48
| Professional | 26 | $11.48 | $20.89 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $47.86 / $107.15
| Professional | TC | $30.90 | $47.86 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $16.60 / $16.60
| Facility | 26 | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $60.26 / $114.82
| Professional | | $43.65 | $60.26 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $19.05 / $32.36
| Professional | 26 | $11.22 | $19.05 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $42.66 / $89.13
| Professional | TC | $30.90 | $42.66 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.16 / $16.98 / $40.74
| Facility | 26 | $3.16 | $16.98 | $40.74 |
- 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
- $10.96 / $19.50 / $38.02
| Professional | 26 | $10.96 | $19.50 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $48.98 / $104.71
| Professional | TC | $29.51 | $48.98 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $53.70 / $102.33
| Professional | | $40.74 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $15.49 / $28.84
| Professional | 26 | $11.48 | $15.49 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $38.02 / $74.13
| Professional | TC | $28.84 | $38.02 | $74.13 |