- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $17.78 / $44.67
| Facility | 26 | $10.96 | $17.78 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $48.98 / $158.49
| Professional | | $33.11 | $48.98 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $17.78 / $47.86
| Professional | 26 | $10.00 | $17.78 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $30.20 / $75.86
| Professional | TC | $21.38 | $30.20 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | 26 | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $47.86 / $93.33
| Professional | | $33.88 | $47.86 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.22 / $30.20
| Professional | 26 | $10.96 | $16.22 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $31.62 / $66.07
| Professional | TC | $22.91 | $31.62 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.02 / $16.22 / $38.90
| Facility | 26 | $3.02 | $16.22 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $53.70 / $109.65
| Professional | | $33.11 | $53.70 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $17.78 / $34.67
| Professional | 26 | $10.23 | $17.78 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $36.31 / $79.43
| Professional | TC | $22.39 | $36.31 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $83.18
| Professional | | $32.36 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $14.45 / $26.92
| Professional | 26 | $10.96 | $14.45 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.84 / $56.23
| Professional | TC | $21.88 | $28.84 | $56.23 |