- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.07 / $26.07 / $26.07
| Facility | 26 | $26.07 | $26.07 | $26.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.25 / $53.13 / $73.79
| Professional | | $38.25 | $53.13 | $73.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.47 / $23.71 / $42.01
| Professional | 26 | $16.47 | $23.71 | $42.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.53 / $30.28 / $49.06
| Professional | TC | $19.53 | $30.28 | $49.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.89 / $58.95 / $104.87
| Professional | | $49.89 | $58.95 | $104.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.80 / $30.81 / $46.98
| Professional | 26 | $23.80 | $30.81 | $46.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.51 / $32.42 / $64.70
| Professional | TC | $20.51 | $32.42 | $64.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $29.37 / $38.81
| Professional | | $22.63 | $29.37 | $38.81 |
- 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
- $76.98 / $90.89 / $118.81
| Professional | | $76.98 | $90.89 | $118.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.46 / $42.43 / $55.31
| Professional | 26 | $32.46 | $42.43 | $55.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.56 / $53.73 / $76.38
| Professional | TC | $31.56 | $53.73 | $76.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.10 / $48.33 / $73.26
| Professional | | $37.10 | $48.33 | $73.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.00 / $25.20 / $33.00
| Professional | 26 | $18.00 | $25.20 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.82 / $27.08 / $46.89
| Professional | TC | $16.82 | $27.08 | $46.89 |