- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.88 / $20.42 / $56.23
| Facility | 26 | $12.88 | $20.42 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $77.62 / $245.47
| Professional | | $50.12 | $77.62 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.02 / $20.42 / $56.23
| Professional | 26 | $12.02 | $20.42 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.31 / $52.48 / $117.49
| Professional | TC | $36.31 | $52.48 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $17.38 / $17.38
| Facility | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $75.86 / $134.90
| Professional | | $51.29 | $75.86 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $21.38 / $38.02
| Professional | 26 | $12.30 | $21.38 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $54.95 / $102.33
| Professional | TC | $39.81 | $54.95 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $3.63 / $19.05 / $45.71
| Facility | 26 | $3.63 | $19.05 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $85.11 / $165.96
| Professional | | $50.12 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $21.88 / $42.66
| Professional | 26 | $12.59 | $21.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $64.57 / $128.82
| Professional | TC | $38.02 | $64.57 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $123.03
| Professional | | $51.29 | $67.61 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.18 / $17.38 / $31.62
| Professional | 26 | $13.18 | $17.38 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $50.12 / $91.20
| Professional | TC | $38.02 | $50.12 | $91.20 |