- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $20.38 / $27.07 / $47.61
| Facility | 26 | $20.38 | $27.07 | $47.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.62 / $63.61 / $109.46
| Professional | | $53.62 | $63.61 | $109.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.67 / $20.37 / $33.99
| Professional | 26 | $17.67 | $20.37 | $33.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.54 / $43.78 / $73.38
| Professional | TC | $34.54 | $43.78 | $73.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.27 / $24.27 / $24.27
| Facility | 26 | $24.27 | $24.27 | $24.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.58 / $75.97 / $128.22
| Professional | | $59.58 | $75.97 | $128.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.69 / $28.32 / $42.16
| Professional | 26 | $20.69 | $28.32 | $42.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.10 / $51.73 / $86.50
| Professional | TC | $38.10 | $51.73 | $86.50 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.92 / $23.92 / $23.92
| Facility | 26 | $23.92 | $23.92 | $23.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.90 / $88.43 / $141.63
| Professional | | $58.90 | $88.43 | $141.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.86 / $30.07 / $48.45
| Professional | 26 | $18.86 | $30.07 | $48.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.77 / $58.58 / $100.29
| Professional | TC | $38.77 | $58.58 | $100.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.84 / $72.61 / $137.66
| Professional | | $58.84 | $72.61 | $137.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.47 / $25.08 / $45.36
| Professional | 26 | $20.47 | $25.08 | $45.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.77 / $48.67 / $83.54
| Professional | TC | $37.77 | $48.67 | $83.54 |