- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.17 / $12.21 / $21.48
| Facility | 26 | $9.17 | $12.21 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.97 / $70.03 / $184.65
| Professional | | $32.97 | $70.03 | $184.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.52 / $9.93 / $27.05
| Professional | 26 | $8.52 | $9.93 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.25 / $51.90 / $96.77
| Professional | TC | $24.25 | $51.90 | $96.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Facility | 26 | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.53 / $56.04 / $141.30
| Professional | | $37.53 | $56.04 | $141.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.10 / $12.96 / $21.57
| Professional | 26 | $9.10 | $12.96 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.29 / $42.66 / $107.73
| Professional | TC | $28.29 | $42.66 | $107.73 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.75 / $76.05 / $149.88
| Professional | | $36.75 | $76.05 | $149.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.60 / $13.72 / $21.89
| Professional | 26 | $8.60 | $13.72 | $21.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.50 / $58.65 / $121.89
| Professional | TC | $28.50 | $58.65 | $121.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.58 / $57.71 / $115.37
| Professional | | $35.58 | $57.71 | $115.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.70 / $11.50 / $20.29
| Professional | 26 | $7.70 | $11.50 | $20.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $43.91 / $95.44
| Professional | TC | $26.30 | $43.91 | $95.44 |