- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.79 / $52.97 / $106.37
| Facility | 26 | $40.79 | $52.97 | $106.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.87 / $226.80 / $278.51
| Professional | | $123.87 | $226.80 | $278.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.39 / $49.17 / $88.94
| Professional | 26 | $41.39 | $49.17 | $88.94 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $60.63 / $69.00 / $85.50
| Professional | 52 | $60.63 | $69.00 | $85.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.19 / $155.59 / $201.03
| Professional | TC | $85.19 | $155.59 | $201.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.22 / $241.43 / $318.08
| Professional | | $131.22 | $241.43 | $318.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.29 / $57.33 / $76.23
| Professional | 26 | $31.29 | $57.33 | $76.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $88.25 / $169.01 / $254.05
| Professional | TC | $88.25 | $169.01 | $254.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.59 / $129.59 / $239.54
| Professional | | $129.59 | $129.59 | $239.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.47 / $51.02 / $417.34
| Professional | 26 | $39.47 | $51.02 | $417.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.46 / $183.91 / $345.32
| Professional | | $116.46 | $183.91 | $345.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.01 / $48.70 / $96.25
| Professional | 26 | $34.01 | $48.70 | $96.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.18 / $185.13 / $273.22
| Professional | TC | $82.18 | $185.13 | $273.22 |