- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $16.98 / $43.65
| Facility | 26 | $10.00 | $16.98 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $47.86 / $125.89
| Professional | | $33.11 | $47.86 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $15.85 / $36.31
| Professional | 26 | $9.77 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $31.62 / $70.79
| Professional | TC | $21.88 | $31.62 | $70.79 |
- 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
- $34.67 / $46.77 / $87.10
| Professional | | $34.67 | $46.77 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $14.13 / $25.70
| Professional | 26 | $10.00 | $14.13 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.44 / $32.36 / $60.26
| Professional | TC | $23.44 | $32.36 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.95 / $15.85 / $38.02
| Facility | 26 | $2.95 | $15.85 | $38.02 |
- 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
- $9.33 / $15.85 / $31.62
| Professional | 26 | $9.33 | $15.85 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $38.90 / $81.28
| Professional | TC | $23.99 | $38.90 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $81.28
| Professional | | $32.36 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.33 / $12.88 / $24.55
| Professional | 26 | $9.33 | $12.88 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $30.20 / $56.23
| Professional | TC | $22.39 | $30.20 | $56.23 |