- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $87.10 / $134.90
| Facility | 26 | $26.92 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $104.71 / $269.15
| Professional | | $70.79 | $104.71 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $30.90 / $93.33
| Professional | 26 | $21.88 | $30.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $72.44 / $208.93
| Professional | TC | $48.98 | $72.44 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $141.25 / $416.87
| Professional | | $104.71 | $141.25 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $46.77 / $125.89
| Professional | 26 | $23.99 | $46.77 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.28 / $102.33 / $302.00
| Professional | TC | $81.28 | $102.33 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $53.70 / $83.18
| Facility | 26 | $10.47 | $53.70 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $128.82 / $338.84
| Professional | | $52.48 | $128.82 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $35.48 / $93.33
| Professional | 26 | $15.85 | $35.48 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.31 / $91.20 / $234.42
| Professional | TC | $36.31 | $91.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $123.03 / $281.84
| Professional | | $64.57 | $123.03 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $36.31 / $81.28
| Professional | 26 | $20.89 | $36.31 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $85.11 / $204.17
| Professional | TC | $44.67 | $85.11 | $204.17 |