- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.19 / $41.06 / $61.81
| Facility | 26 | $32.19 | $41.06 | $61.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.89 / $105.14 / $129.19
| Professional | | $56.89 | $105.14 | $129.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.98 / $36.49 / $42.54
| Professional | 26 | $25.98 | $36.49 | $42.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.03 / $73.72 / $91.87
| Professional | TC | $16.03 | $73.72 | $91.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.04 / $122.85 / $168.69
| Professional | | $46.04 | $122.85 | $168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.94 / $95.28 / $168.14
| Professional | | $48.94 | $95.28 | $168.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.32 / $39.20 / $60.77
| Professional | 26 | $33.32 | $39.20 | $60.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.79 / $32.24 / $105.26
| Professional | TC | $10.79 | $32.24 | $105.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.97 / $196.24 / $196.24
| Facility | 26 | $92.97 | $196.24 | $196.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.41 / $125.01 / $886.70
| Professional | | $70.41 | $125.01 | $886.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $46.90 / $414.43
| Professional | 26 | $34.65 | $46.90 | $414.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.83 / $74.06 / $639.54
| Professional | TC | $21.83 | $74.06 | $639.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.41 / $107.07 / $166.59
| Professional | | $70.41 | $107.07 | $166.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.59 / $44.86 / $61.97
| Professional | 26 | $33.59 | $44.86 | $61.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.13 / $71.59 / $116.25
| Professional | TC | $44.13 | $71.59 | $116.25 |