- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.05 / $283.20 / $284.04
| Facility | 26 | $27.05 | $283.20 | $284.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.75 / $54.54 / $232.00
| Professional | | $41.75 | $54.54 | $232.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.37 / $41.25 / $113.36
| Professional | 26 | $21.37 | $41.25 | $113.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.48 / $23.98 / $96.00
| Professional | TC | $18.48 | $23.98 | $96.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.80 / $64.98 / $104.43
| Professional | | $49.80 | $64.98 | $104.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.61 / $34.34 / $51.28
| Professional | 26 | $25.61 | $34.34 | $51.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.17 / $28.96 / $58.61
| Professional | TC | $23.17 | $28.96 | $58.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.96 / $38.52 / $66.43
| Professional | | $24.96 | $38.52 | $66.43 |
- 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
- $66.43 / $83.84 / $100.52
| Professional | | $66.43 | $83.84 | $100.52 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.70 / $44.10 / $55.04
| Professional | 26 | $34.70 | $44.10 | $55.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.73 / $39.74 / $47.30
| Professional | TC | $31.73 | $39.74 | $47.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.46 / $48.84 / $76.84
| Professional | | $46.46 | $48.84 | $76.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.34 / $25.62 / $41.33
| Professional | 26 | $24.34 | $25.62 | $41.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.92 / $22.02 / $35.52
| Professional | TC | $20.92 | $22.02 | $35.52 |