- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $17.38 / $46.77
| Facility | 26 | $10.00 | $17.38 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $45.71 / $109.65
| Professional | | $33.11 | $45.71 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $12.88 / $30.90
| Professional | 26 | $8.91 | $12.88 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $33.88 / $70.79
| Professional | TC | $23.99 | $33.88 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Facility | 26 | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $51.29 / $95.50
| Professional | | $37.15 | $51.29 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $14.13 / $25.12
| Professional | 26 | $9.55 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $38.02 / $70.79
| Professional | TC | $27.54 | $38.02 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.88 / $15.49 / $37.15
| Facility | 26 | $2.88 | $15.49 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $60.26 / $114.82
| Professional | | $35.48 | $60.26 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $15.14 / $30.90
| Professional | 26 | $9.12 | $15.14 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $43.65 / $89.13
| Professional | TC | $25.70 | $43.65 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $46.77 / $87.10
| Professional | | $35.48 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $12.59 / $23.99
| Professional | 26 | $9.12 | $12.59 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $34.67 / $63.10
| Professional | TC | $25.70 | $34.67 | $63.10 |