- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.01 / $29.44 / $54.47
| Facility | 26 | $23.01 | $29.44 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.72 / $50.29 / $232.00
| Professional | | $39.72 | $50.29 | $232.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.90 / $24.88 / $105.96
| Professional | 26 | $20.90 | $24.88 | $105.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.21 / $23.10 / $43.86
| Professional | TC | $18.21 | $23.10 | $43.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.79 / $27.79 / $27.79
| Facility | 26 | $27.79 | $27.79 | $27.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.86 / $62.69 / $100.97
| Professional | | $42.86 | $62.69 | $100.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.15 / $31.62 / $48.45
| Professional | 26 | $23.15 | $31.62 | $48.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.18 / $29.23 / $56.24
| Professional | TC | $20.18 | $29.23 | $56.24 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.99 / $26.99 / $26.99
| Facility | 26 | $26.99 | $26.99 | $26.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.49 / $67.42 / $124.61
| Professional | | $40.49 | $67.42 | $124.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.66 / $32.85 / $56.37
| Professional | 26 | $21.66 | $32.85 | $56.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.70 / $31.61 / $66.73
| Professional | TC | $18.70 | $31.61 | $66.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.25 / $57.77 / $101.51
| Professional | | $44.25 | $57.77 | $101.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.86 / $27.82 / $48.84
| Professional | 26 | $22.86 | $27.82 | $48.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.73 / $26.82 / $54.02
| Professional | TC | $19.73 | $26.82 | $54.02 |