- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $15.85 / $40.74
| Facility | 26 | $9.33 | $15.85 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $51.29 / $190.55
| Professional | | $32.36 | $51.29 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $14.13 / $37.15
| Professional | 26 | $8.91 | $14.13 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $34.67 / $79.43
| Professional | TC | $22.91 | $34.67 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Facility | 26 | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $51.29 / $93.33
| Professional | | $36.31 | $51.29 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $14.13 / $25.12
| Professional | 26 | $10.23 | $14.13 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.92 / $38.02 / $69.18
| Professional | TC | $26.92 | $38.02 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.63 / $13.80 / $33.88
| Facility | 26 | $2.63 | $13.80 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $57.54 / $112.20
| Professional | | $33.11 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $15.14 / $29.51
| Professional | 26 | $9.12 | $15.14 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $42.66 / $83.18
| Professional | TC | $24.55 | $42.66 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $45.71 / $83.18
| Professional | | $33.88 | $45.71 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $12.02 / $22.39
| Professional | 26 | $9.12 | $12.02 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $33.88 / $61.66
| Professional | TC | $24.55 | $33.88 | $61.66 |