- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.59 / $31.59 / $31.59
| Facility | 26 | $31.59 | $31.59 | $31.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.17 / $58.82 / $83.93
| Professional | | $48.17 | $58.82 | $83.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.78 / $28.82 / $50.88
| Professional | 26 | $20.78 | $28.82 | $50.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.14 / $29.74 / $48.18
| Professional | TC | $19.14 | $29.74 | $48.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.39 / $63.53 / $109.47
| Professional | | $55.39 | $63.53 | $109.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.32 / $37.31 / $58.39
| Professional | 26 | $29.32 | $37.31 | $58.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.07 / $30.29 / $58.98
| Professional | TC | $20.07 | $30.29 | $58.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $33.89 / $64.69
| Professional | | $24.84 | $33.89 | $64.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $67.61 / $67.61 / $67.61
| Facility | 26 | $67.61 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.58 / $101.86 / $126.59
| Professional | | $86.58 | $101.86 | $126.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.03 / $52.33 / $66.98
| Professional | 26 | $40.03 | $52.33 | $66.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.56 / $40.15 / $74.26
| Professional | TC | $31.56 | $40.15 | $74.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.95 / $54.72 / $78.45
| Professional | | $41.95 | $54.72 | $78.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.50 / $29.25 / $40.00
| Professional | 26 | $22.50 | $29.25 | $40.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.64 / $27.72 / $45.70
| Professional | TC | $16.64 | $27.72 | $45.70 |