- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $45.71 / $120.23
| Facility | 26 | $27.54 | $45.71 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $125.89 / $467.74
| Professional | | $67.61 | $125.89 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $41.69 / $91.20
| Professional | 26 | $25.12 | $41.69 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $85.11 / $229.09
| Professional | TC | $42.66 | $85.11 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | 26 | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $114.82 / $223.87
| Professional | | $69.18 | $114.82 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $33.88 / $64.57
| Professional | 26 | $26.92 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.69 / $81.28 / $158.49
| Professional | TC | $41.69 | $81.28 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $35.48 / $87.10
| Facility | 26 | $6.76 | $35.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $144.54 / $309.03
| Professional | | $83.18 | $144.54 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $38.90 / $79.43
| Professional | 26 | $21.88 | $38.90 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $102.33 / $223.87
| Professional | TC | $58.88 | $102.33 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $109.65 / $213.80
| Professional | | $79.43 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $30.90 / $58.88
| Professional | 26 | $22.91 | $30.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $79.43 / $154.88
| Professional | TC | $56.23 | $79.43 | $154.88 |