- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $16.54 / $19.72 / $37.58
| Facility | 26 | $16.54 | $19.72 | $37.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.64 / $72.25 / $135.71
| Professional | | $61.64 | $72.25 | $135.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.67 / $16.54 / $30.35
| Professional | 26 | $14.67 | $16.54 | $30.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.00 / $54.32 / $104.45
| Professional | TC | $46.00 | $54.32 | $104.45 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.57 / $18.57 / $18.57
| Facility | 26 | $18.57 | $18.57 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.05 / $88.71 / $143.57
| Professional | | $69.05 | $88.71 | $143.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.50 / $22.46 / $34.25
| Professional | 26 | $16.50 | $22.46 | $34.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.61 / $70.59 / $112.38
| Professional | TC | $54.61 | $70.59 | $112.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.60 / $19.60 / $19.60
| Facility | 26 | $19.60 | $19.60 | $19.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.05 / $95.38 / $166.46
| Professional | | $66.05 | $95.38 | $166.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.55 / $23.92 / $40.09
| Professional | 26 | $15.55 | $23.92 | $40.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.72 / $71.65 / $129.47
| Professional | TC | $49.72 | $71.65 | $129.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.56 / $85.34 / $150.59
| Professional | | $64.56 | $85.34 | $150.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.80 / $21.20 / $37.14
| Professional | 26 | $16.80 | $21.20 | $37.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.65 / $64.22 / $113.82
| Professional | TC | $47.65 | $64.22 | $113.82 |