- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.60 / $31.26 / $42.21
| Facility | 26 | $21.60 | $31.26 | $42.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.92 / $61.57 / $73.73
| Professional | | $30.92 | $61.57 | $73.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.61 / $22.04 / $32.83
| Professional | 26 | $15.61 | $22.04 | $32.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.97 / $30.30 / $56.82
| Professional | TC | $15.97 | $30.30 | $56.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.20 / $56.10 / $78.59
| Professional | | $35.20 | $56.10 | $78.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.30 / $25.96 / $28.65
| Professional | 26 | $17.30 | $25.96 | $28.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.81 / $29.81 / $29.81
| Professional | TC | $29.81 | $29.81 | $29.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.88 / $91.00 / $107.38
| Professional | | $55.88 | $91.00 | $107.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.71 / $27.00 / $31.86
| Professional | 26 | $19.71 | $27.00 | $31.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.44 / $64.00 / $75.52
| Professional | TC | $28.44 | $64.00 | $75.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.48 / $21.48 / $21.48
| Facility | 26 | $21.48 | $21.48 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.69 / $64.79 / $151.79
| Professional | | $38.69 | $64.79 | $151.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.98 / $24.81 / $66.33
| Professional | 26 | $16.98 | $24.81 | $66.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.70 / $34.47 / $115.04
| Professional | TC | $19.70 | $34.47 | $115.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.58 / $46.97 / $110.28
| Professional | | $35.58 | $46.97 | $110.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.82 / $22.74 / $30.31
| Professional | 26 | $16.82 | $22.74 | $30.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.13 / $23.57 / $83.91
| Professional | TC | $18.13 | $23.57 | $83.91 |