- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.34 / $27.34 / $27.86
| Facility | 26 | $27.34 | $27.34 | $27.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.42 / $50.14 / $63.60
| Professional | | $40.42 | $50.14 | $63.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.40 / $54.14 / $123.77
| Professional | 26 | $24.40 | $54.14 | $123.77 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $49.33 / $49.33 / $88.50
| Professional | 52 | $49.33 | $49.33 | $88.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.29 / $23.57 / $31.02
| Professional | TC | $17.29 | $23.57 | $31.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.00 / $222.00 / $222.00
| Professional | | $134.00 | $222.00 | $222.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.00 / $121.00 / $121.00
| Professional | 26 | $73.00 | $121.00 | $121.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.00 / $101.00 / $101.00
| Professional | TC | $61.00 | $101.00 | $101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.93 / $82.67 / $144.76
| Professional | | $55.93 | $82.67 | $144.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.68 / $44.32 / $78.55
| Professional | 26 | $31.68 | $44.32 | $78.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.25 / $37.25 / $66.20
| Professional | TC | $24.25 | $37.25 | $66.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.67 / $98.24 / $172.69
| Professional | | $58.67 | $98.24 | $172.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.77 / $53.88 / $93.50
| Professional | 26 | $31.77 | $53.88 | $93.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.90 / $44.36 / $79.19
| Professional | TC | $26.90 | $44.36 | $79.19 |