- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $20.42 / $56.23
| Facility | 26 | $12.88 | $20.42 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $69.18 / $208.93
| Professional | | $48.98 | $69.18 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $19.95 / $54.95
| Professional | 26 | $12.02 | $19.95 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.88 / $45.71 / $114.82
| Professional | TC | $33.88 | $45.71 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $16.98 / $16.98
| Facility | 26 | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $69.18 / $138.04
| Professional | | $51.29 | $69.18 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $19.50 / $36.31
| Professional | 26 | $12.88 | $19.50 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.31 / $50.12 / $102.33
| Professional | TC | $36.31 | $50.12 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.72 / $19.50 / $47.86
| Facility | 26 | $3.72 | $19.50 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $77.62 / $158.49
| Professional | | $46.77 | $77.62 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $21.38 / $41.69
| Professional | 26 | $12.30 | $21.38 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.48 / $57.54 / $120.23
| Professional | TC | $35.48 | $57.54 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $61.66 / $117.49
| Professional | | $46.77 | $61.66 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $17.38 / $32.36
| Professional | 26 | $12.88 | $17.38 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.88 / $44.67 / $87.10
| Professional | TC | $33.88 | $44.67 | $87.10 |