- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $61.66 / $95.50
| Facility | 26 | $19.05 | $61.66 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $169.82 / $354.81
| Professional | | $91.20 | $169.82 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $22.91 / $112.20
| Professional | 26 | $15.85 | $22.91 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.43 / $141.25 / $323.59
| Professional | TC | $79.43 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $138.04 / $407.38
| Professional | | $64.57 | $138.04 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $28.18 / $89.13
| Professional | 26 | $20.42 | $28.18 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.67 / $141.25 / $323.59
| Professional | TC | $44.67 | $141.25 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $63.10 / $109.65
| Facility | 26 | $13.49 | $63.10 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $173.78 / $363.08
| Professional | | $77.62 | $173.78 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $28.18 / $75.86
| Professional | 26 | $11.22 | $28.18 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $134.90 / $302.00
| Professional | TC | $60.26 | $134.90 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $165.96 / $363.08
| Professional | | $97.72 | $165.96 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $26.92 / $63.10
| Professional | 26 | $15.14 | $26.92 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.18 / $134.90 / $309.03
| Professional | TC | $83.18 | $134.90 | $309.03 |