- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.75 / $16.96 / $27.56
| Facility | 26 | $12.75 | $16.96 | $27.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.49 / $58.18 / $147.66
| Professional | | $46.49 | $58.18 | $147.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.84 / $16.20 / $40.33
| Professional | 26 | $11.84 | $16.20 | $40.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.61 / $40.61 / $79.05
| Professional | TC | $33.61 | $40.61 | $79.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.78 / $16.78 / $16.78
| Facility | 26 | $16.78 | $16.78 | $16.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.02 / $65.40 / $105.57
| Professional | | $47.02 | $65.40 | $105.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.71 / $18.52 / $27.35
| Professional | 26 | $12.71 | $18.52 | $27.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.56 / $45.82 / $80.20
| Professional | TC | $33.56 | $45.82 | $80.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.65 / $14.65 / $14.65
| Facility | 26 | $14.65 | $14.65 | $14.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.61 / $66.66 / $113.55
| Professional | | $44.61 | $66.66 | $113.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.60 / $19.89 / $32.59
| Professional | 26 | $12.60 | $19.89 | $32.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.79 / $47.86 / $85.12
| Professional | TC | $32.79 | $47.86 | $85.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.13 / $57.10 / $98.58
| Professional | | $46.13 | $57.10 | $98.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.37 / $17.17 / $32.34
| Professional | 26 | $13.37 | $17.17 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.68 / $40.90 / $70.64
| Professional | TC | $31.68 | $40.90 | $70.64 |