- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $12.59 / $35.48
| Facility | 26 | $8.13 | $12.59 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $63.10 / $245.47
| Professional | | $32.36 | $63.10 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $11.22 / $38.02
| Professional | 26 | $7.94 | $11.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $38.02 / $151.36
| Professional | TC | $22.91 | $38.02 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Facility | 26 | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $70.79 / $177.83
| Professional | | $32.36 | $70.79 | $177.83 |
- 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
- $24.55 / $51.29 / $151.36
| Professional | TC | $24.55 | $51.29 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.29 / $12.30 / $29.51
| Facility | 26 | $2.29 | $12.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $70.79 / $158.49
| Professional | | $33.88 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $13.49 / $25.70
| Professional | 26 | $7.94 | $13.49 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $57.54 / $125.89
| Professional | TC | $25.12 | $57.54 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $53.70 / $117.49
| Professional | | $30.90 | $53.70 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $10.47 / $20.42
| Professional | 26 | $7.41 | $10.47 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $40.74 / $97.72
| Professional | TC | $22.91 | $40.74 | $97.72 |