- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.11 / $27.07 / $47.61
| Facility | 26 | $24.11 | $27.07 | $47.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.97 / $63.61 / $76.86
| Professional | | $60.97 | $63.61 | $76.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.57 / $20.71 / $24.80
| Professional | 26 | $19.57 | $20.71 | $24.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.93 / $42.90 / $50.11
| Professional | TC | $40.93 | $42.90 | $50.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.65 / $96.65 / $96.65
| Professional | | $96.65 | $96.65 | $96.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.75 / $90.97 / $121.00
| Professional | | $51.75 | $90.97 | $121.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.16 / $30.07 / $40.70
| Professional | 26 | $18.16 | $30.07 | $40.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.94 / $61.35 / $85.78
| Professional | TC | $34.94 | $61.35 | $85.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $49.19 / $49.19 / $94.47
| Facility | 26 | $49.19 | $49.19 | $94.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.15 / $74.73 / $420.07
| Professional | | $64.15 | $74.73 | $420.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.89 / $25.99 / $132.09
| Professional | 26 | $21.89 | $25.99 | $132.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.94 / $48.52 / $288.04
| Professional | TC | $40.94 | $48.52 | $288.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.90 / $70.54 / $109.21
| Professional | | $62.90 | $70.54 | $109.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.89 / $24.08 / $38.36
| Professional | 26 | $21.89 | $24.08 | $38.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.21 / $45.65 / $70.53
| Professional | TC | $40.21 | $45.65 | $70.53 |