- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $16.98 / $43.65
| Facility | 26 | $10.96 | $16.98 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $72.44 / $199.53
| Professional | | $42.66 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $20.42 / $53.70
| Professional | 26 | $10.96 | $20.42 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.90 / $46.77 / $95.50
| Professional | TC | $30.90 | $46.77 | $95.50 |
- 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
- $41.69 / $61.66 / $109.65
| Professional | | $41.69 | $61.66 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $18.62 / $32.36
| Professional | 26 | $10.96 | $18.62 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $42.66 / $79.43
| Professional | TC | $31.62 | $42.66 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.09 / $16.60 / $38.90
| Facility | 26 | $3.09 | $16.60 | $38.90 |
- 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
- $10.72 / $19.05 / $36.31
| Professional | 26 | $10.72 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $50.12 / $104.71
| Professional | TC | $30.20 | $50.12 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $53.70 / $97.72
| Professional | | $40.74 | $53.70 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $15.49 / $28.18
| Professional | 26 | $11.22 | $15.49 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.84 / $38.90 / $72.44
| Professional | TC | $28.84 | $38.90 | $72.44 |