- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.95 / $37.47 / $56.60
| Facility | 26 | $31.95 | $37.47 | $56.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.23 / $80.50 / $141.40
| Professional | | $69.23 | $80.50 | $141.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.62 / $33.78 / $70.52
| Professional | 26 | $28.62 | $33.78 | $70.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.94 / $48.00 / $83.76
| Professional | TC | $40.94 | $48.00 | $83.76 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.43 / $36.43 / $36.43
| Facility | 26 | $36.43 | $36.43 | $36.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $93.36 / $161.60
| Professional | | $75.42 | $93.36 | $161.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.89 / $39.58 / $67.39
| Professional | 26 | $30.89 | $39.58 | $67.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.40 / $56.25 / $95.46
| Professional | TC | $44.40 | $56.25 | $95.46 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.82 / $37.82 / $37.82
| Facility | 26 | $37.82 | $37.82 | $37.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.76 / $108.14 / $175.50
| Professional | | $72.76 | $108.14 | $175.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.70 / $47.28 / $76.73
| Professional | 26 | $29.70 | $47.28 | $76.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.10 / $62.59 / $106.02
| Professional | TC | $43.10 | $62.59 | $106.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.36 / $92.42 / $159.09
| Professional | | $75.36 | $92.42 | $159.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.72 / $40.18 / $69.76
| Professional | 26 | $32.72 | $40.18 | $69.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.06 / $52.80 / $92.45
| Professional | TC | $43.06 | $52.80 | $92.45 |