- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.29 / $17.29 / $82.74
| Facility | 26 | $17.29 | $17.29 | $82.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.64 / $52.51 / $267.00
| Professional | | $43.64 | $52.51 | $267.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.58 / $17.63 / $70.45
| Professional | 26 | $13.58 | $17.63 | $70.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.03 / $35.22 / $68.45
| Professional | TC | $30.03 | $35.22 | $68.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.69 / $59.68 / $97.86
| Professional | | $47.69 | $59.68 | $97.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.13 / $21.02 / $32.31
| Professional | 26 | $16.13 | $21.02 | $32.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.27 / $39.22 / $62.90
| Professional | TC | $30.27 | $39.22 | $62.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.48 / $28.95 / $38.81
| Professional | | $22.48 | $28.95 | $38.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $83.49 / $99.83
| Professional | | $74.36 | $83.49 | $99.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.31 / $27.95 / $33.72
| Professional | 26 | $22.31 | $27.95 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.76 / $55.02 / $69.67
| Professional | TC | $51.76 | $55.02 | $69.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.22 / $49.08 / $81.59
| Professional | | $45.22 | $49.08 | $81.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.30 / $16.23 / $28.35
| Professional | 26 | $15.30 | $16.23 | $28.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.60 / $32.96 / $55.60
| Professional | TC | $30.60 | $32.96 | $55.60 |