- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $14.79 / $40.74
| Facility | 26 | $8.91 | $14.79 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $40.74 / $141.25
| Professional | | $28.18 | $40.74 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.88 / $33.11
| Professional | 26 | $7.94 | $12.88 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $25.70 / $57.54
| Professional | TC | $19.05 | $25.70 | $57.54 |
- 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
- $29.51 / $40.74 / $75.86
| Professional | | $29.51 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $13.80 / $24.55
| Professional | 26 | $8.71 | $13.80 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $28.18 / $52.48
| Professional | TC | $21.38 | $28.18 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.45 / $13.18 / $31.62
| Facility | 26 | $2.45 | $13.18 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $47.86 / $93.33
| Professional | | $28.18 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $14.79 / $28.84
| Professional | 26 | $8.51 | $14.79 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $33.11 / $67.61
| Professional | TC | $19.50 | $33.11 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $37.15 / $69.18
| Professional | | $28.18 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $11.75 / $21.88
| Professional | 26 | $8.91 | $11.75 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $25.70 / $46.77
| Professional | TC | $19.05 | $25.70 | $46.77 |