- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.40 / $13.56 / $22.30
| Facility | 26 | $10.40 | $13.56 | $22.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.36 / $46.61 / $79.98
| Professional | | $34.36 | $46.61 | $79.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.36 / $11.06 / $24.00
| Professional | 26 | $9.36 | $11.06 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.87 / $36.57 / $57.59
| Professional | TC | $24.87 | $36.57 | $57.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.82 / $11.82 / $11.82
| Facility | 26 | $11.82 | $11.82 | $11.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.70 / $47.74 / $83.08
| Professional | | $37.70 | $47.74 | $83.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.35 / $14.54 / $21.64
| Professional | 26 | $10.35 | $14.54 | $21.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.44 / $36.36 / $59.62
| Professional | TC | $27.44 | $36.36 | $59.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $12.30 / $12.30
| Facility | 26 | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.85 / $57.85 / $93.79
| Professional | | $36.85 | $57.85 | $93.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.82 / $15.41 / $24.78
| Professional | 26 | $9.82 | $15.41 | $24.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.56 / $43.27 / $68.26
| Professional | TC | $26.56 | $43.27 | $68.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.86 / $48.26 / $80.12
| Professional | | $37.86 | $48.26 | $80.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $13.25 / $23.06
| Professional | 26 | $10.23 | $13.25 | $23.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.08 / $35.71 / $60.15
| Professional | TC | $27.08 | $35.71 | $60.15 |