- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $19.05 / $46.77
| Facility | 26 | $10.96 | $19.05 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $56.23 / $128.82
| Professional | | $34.67 | $56.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $15.14 / $44.67
| Professional | 26 | $7.94 | $15.14 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $33.88 / $109.65
| Professional | TC | $21.88 | $33.88 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $9.55 / $9.55
| Facility | 26 | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $66.07 / $134.90
| Professional | | $41.69 | $66.07 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $14.45 / $26.92
| Professional | 26 | $8.32 | $14.45 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $52.48 / $112.20
| Professional | TC | $27.54 | $52.48 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.63 / $19.50 / $45.71
| Facility | 26 | $3.63 | $19.50 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $69.18 / $134.90
| Professional | | $37.15 | $69.18 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $15.14 / $38.90
| Professional | 26 | $8.71 | $15.14 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $53.70 / $107.15
| Professional | TC | $24.55 | $53.70 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $56.23 / $107.15
| Professional | | $37.15 | $56.23 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $15.14 / $28.84
| Professional | 26 | $7.76 | $15.14 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $39.81 / $89.13
| Professional | TC | $23.99 | $39.81 | $89.13 |