- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.36 / $42.89 / $55.90
| Facility | 26 | $34.36 | $42.89 | $55.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.61 / $88.42 / $134.96
| Professional | | $68.61 | $88.42 | $134.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.67 / $38.86 / $51.21
| Professional | 26 | $27.67 | $38.86 | $51.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.94 / $49.79 / $83.76
| Professional | TC | $40.94 | $49.79 | $83.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.04 / $36.46 / $36.46
| Professional | 26 | $31.04 | $36.46 | $36.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.51 / $108.73 / $138.16
| Professional | | $94.51 | $108.73 | $138.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.77 / $49.69 / $62.23
| Professional | 26 | $38.77 | $49.69 | $62.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.74 / $63.76 / $84.04
| Professional | TC | $55.74 | $63.76 | $84.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.27 / $30.27 / $31.68
| Professional | 26 | $30.27 | $30.27 | $31.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.14 / $82.14 / $144.78
| Professional | | $48.14 | $82.14 | $144.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.64 / $36.24 / $62.40
| Professional | 26 | $20.64 | $36.24 | $62.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.50 / $46.45 / $82.71
| Professional | TC | $27.50 | $46.45 | $82.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.48 / $84.95 / $141.22
| Professional | | $61.48 | $84.95 | $141.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.69 / $36.82 / $62.27
| Professional | 26 | $27.69 | $36.82 | $62.27 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.79 / $48.00 / $73.08
| Professional | TC | $33.79 | $48.00 | $73.08 |