- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.40 / $40.25 / $54.33
| Facility | 26 | $39.40 | $40.25 | $54.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.53 / $75.53 / $103.70
| Professional | | $42.53 | $75.53 | $103.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.05 / $35.06 / $42.74
| Professional | 26 | $20.05 | $35.06 | $42.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.53 / $35.28 / $78.92
| Professional | TC | $11.53 | $35.28 | $78.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $41.07 / $96.36
| Professional | | $38.65 | $41.07 | $96.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.53 / $44.14 / $52.22
| Professional | 26 | $31.53 | $44.14 | $52.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.00 / $120.00 / $141.60
| Professional | | $84.00 | $120.00 | $141.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.50 / $75.00 / $88.50
| Professional | 26 | $52.50 | $75.00 | $88.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.50 / $45.00 / $53.10
| Professional | TC | $31.50 | $45.00 | $53.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.49 / $133.47 / $317.33
| Professional | | $45.49 | $133.47 | $317.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.09 / $41.10 / $104.13
| Professional | 26 | $30.09 | $41.10 | $104.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.65 / $95.42 / $232.72
| Professional | TC | $9.65 | $95.42 | $232.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.28 / $76.67 / $157.44
| Professional | | $59.28 | $76.67 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.09 / $30.52 / $43.33
| Professional | 26 | $24.09 | $30.52 | $43.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.84 / $46.92 / $111.67
| Professional | TC | $32.84 | $46.92 | $111.67 |