- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.79 / $26.92 / $72.44
| Facility | 26 | $14.79 | $26.92 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $112.20
| Professional | | $32.36 | $45.71 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $16.60 / $54.95
| Professional | 26 | $12.30 | $16.60 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.95 / $28.84 / $60.26
| Professional | TC | $19.95 | $28.84 | $60.26 |
- 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
- $38.02 / $53.70 / $100.00
| Professional | | $38.02 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.80 / $20.42 / $34.67
| Professional | 26 | $13.80 | $20.42 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $33.88 / $67.61
| Professional | TC | $23.99 | $33.88 | $67.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.98 / $21.38 / $52.48
| Facility | 26 | $3.98 | $21.38 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $60.26 / $117.49
| Professional | | $34.67 | $60.26 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $21.88 / $43.65
| Professional | 26 | $13.49 | $21.88 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $39.81 / $79.43
| Professional | TC | $21.88 | $39.81 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $48.98 / $91.20
| Professional | | $36.31 | $48.98 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $17.78 / $33.88
| Professional | 26 | $13.18 | $17.78 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $30.90 / $57.54
| Professional | TC | $21.88 | $30.90 | $57.54 |