- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.64 / $41.73 / $137.34
| Facility | 26 | $36.64 | $41.73 | $137.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.43 / $67.17 / $114.61
| Professional | | $55.43 | $67.17 | $114.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.50 / $36.64 / $54.47
| Professional | 26 | $32.50 | $36.64 | $54.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.32 / $30.53 / $67.03
| Professional | TC | $19.32 | $30.53 | $67.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.26 / $32.26 / $50.03
| Professional | 26 | $32.26 | $32.26 | $50.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.44 / $89.87 / $110.92
| Professional | | $55.44 | $89.87 | $110.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.04 / $41.83 / $59.04
| Professional | 26 | $33.04 | $41.83 | $59.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.57 / $45.21 / $58.12
| Professional | TC | $20.57 | $45.21 | $58.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.68 / $28.68 / $30.35
| Professional | 26 | $28.68 | $28.68 | $30.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.85 / $77.09 / $130.97
| Professional | | $54.85 | $77.09 | $130.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.22 / $42.00 / $67.37
| Professional | 26 | $30.22 | $42.00 | $67.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.57 / $38.92 / $65.31
| Professional | TC | $23.57 | $38.92 | $65.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.25 / $56.72 / $96.81
| Professional | | $44.25 | $56.72 | $96.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.56 / $32.29 / $54.07
| Professional | 26 | $25.56 | $32.29 | $54.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.67 / $24.54 / $42.11
| Professional | TC | $15.67 | $24.54 | $42.11 |