- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $13.80 / $34.67
| Facility | 26 | $9.12 | $13.80 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $47.86 / $144.54
| Professional | | $30.90 | $47.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $15.49 / $33.11
| Professional | 26 | $8.13 | $15.49 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $30.20 / $75.86
| Professional | TC | $20.89 | $30.20 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Facility | 26 | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $41.69 / $77.62
| Professional | | $31.62 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $12.59 / $21.88
| Professional | 26 | $8.71 | $12.59 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $29.51 / $56.23
| Professional | TC | $21.88 | $29.51 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.63 / $14.13 / $33.88
| Facility | 26 | $2.63 | $14.13 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $48.98 / $97.72
| Professional | | $29.51 | $48.98 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $13.80 / $28.18
| Professional | 26 | $8.13 | $13.80 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $35.48 / $74.13
| Professional | TC | $21.38 | $35.48 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.90 / $74.13
| Professional | | $29.51 | $38.90 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $12.02 / $22.39
| Professional | 26 | $8.32 | $12.02 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $26.92 / $52.48
| Professional | TC | $20.42 | $26.92 | $52.48 |