- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $39.81 / $95.50
| Facility | 26 | $26.30 | $39.81 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $138.04 / $512.86
| Professional | | $77.62 | $138.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $51.29 / $131.83
| Professional | 26 | $26.92 | $51.29 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $83.18 / $204.17
| Professional | TC | $52.48 | $83.18 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | 26 | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $204.17
| Professional | | $87.10 | $114.82 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.84 / $38.02 / $66.07
| Professional | 26 | $28.84 | $38.02 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $81.28 / $141.25
| Professional | TC | $58.88 | $81.28 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.41 / $38.90 / $95.50
| Facility | 26 | $7.41 | $38.90 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $131.83 / $269.15
| Professional | | $74.13 | $131.83 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $41.69 / $79.43
| Professional | 26 | $25.12 | $41.69 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.86 / $89.13 / $190.55
| Professional | TC | $47.86 | $89.13 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $112.20 / $204.17
| Professional | | $77.62 | $112.20 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.70 / $33.88 / $61.66
| Professional | 26 | $25.70 | $33.88 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.12 / $77.62 / $141.25
| Professional | TC | $50.12 | $77.62 | $141.25 |