- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $57.66 / $73.22 / $78.70
| Facility | 26 | $57.66 | $73.22 | $78.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $96.57 / $118.11
| Professional | | $55.57 | $96.57 | $118.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.99 / $67.56 / $80.54
| Professional | 26 | $37.99 | $67.56 | $80.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.57 / $26.32 / $33.35
| Professional | TC | $17.57 | $26.32 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.71 / $50.71 / $50.71
| Professional | | $50.71 | $50.71 | $50.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.53 / $97.88 / $114.17
| Professional | | $75.53 | $97.88 | $114.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.78 / $70.45 / $81.37
| Professional | 26 | $53.78 | $70.45 | $81.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.76 / $27.43 / $32.64
| Professional | TC | $21.76 | $27.43 | $32.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $42.13 / $42.13
| Professional | 26 | $40.00 | $42.13 | $42.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.55 / $66.89 / $109.74
| Professional | | $43.55 | $66.89 | $109.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.46 / $47.37 / $80.08
| Professional | 26 | $31.46 | $47.37 | $80.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.09 / $19.67 / $29.93
| Professional | TC | $12.09 | $19.67 | $29.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.00 / $71.51 / $113.73
| Professional | | $49.00 | $71.51 | $113.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.00 / $47.84 / $79.45
| Professional | 26 | $34.00 | $47.84 | $79.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.56 / $19.32 / $29.43
| Professional | TC | $13.56 | $19.32 | $29.43 |