- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.72 / $26.92
| Facility | 26 | $7.08 | $10.72 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $41.69 / $141.25
| Professional | | $23.99 | $41.69 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $10.72 / $33.88
| Professional | 26 | $6.61 | $10.72 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $22.39 / $52.48
| Professional | TC | $15.85 | $22.39 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $7.76 / $7.76
| Facility | 26 | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $42.66 / $85.11
| Professional | | $24.55 | $42.66 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.72 / $19.95
| Professional | 26 | $7.08 | $10.72 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $33.88 / $66.07
| Professional | TC | $17.78 | $33.88 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $1.74 / $9.12 / $21.88
| Facility | 26 | $1.74 | $9.12 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $43.65 / $81.28
| Professional | | $25.70 | $43.65 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $10.72 / $20.89
| Professional | 26 | $7.41 | $10.72 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $32.36 / $63.10
| Professional | TC | $19.50 | $32.36 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $36.31 / $67.61
| Professional | | $23.99 | $36.31 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.46 / $9.12 / $16.22
| Professional | 26 | $6.46 | $9.12 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $25.70 / $51.29
| Professional | TC | $16.98 | $25.70 | $51.29 |