- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.35 / $36.33 / $46.63
| Facility | 26 | $29.35 | $36.33 | $46.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.50 / $131.46 / $201.42
| Professional | | $88.50 | $131.46 | $201.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.98 / $33.31 / $45.31
| Professional | 26 | $21.98 | $33.31 | $45.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.45 / $98.61 / $156.10
| Professional | TC | $66.45 | $98.61 | $156.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.47 / $162.30 / $190.77
| Professional | | $146.47 | $162.30 | $190.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.22 / $42.30 / $52.31
| Professional | 26 | $33.22 | $42.30 | $52.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $109.63 / $120.00 / $142.22
| Professional | TC | $109.63 | $120.00 | $142.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.27 / $25.27 / $27.92
| Professional | 26 | $25.27 | $25.27 | $27.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.37 / $123.20 / $210.93
| Professional | | $72.37 | $123.20 | $210.93 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.20 / $31.03 / $52.71
| Professional | 26 | $17.20 | $31.03 | $52.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.17 / $94.38 / $157.15
| Professional | TC | $55.17 | $94.38 | $157.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.68 / $125.23 / $194.02
| Professional | | $83.68 | $125.23 | $194.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.95 / $30.56 / $46.06
| Professional | 26 | $22.95 | $30.56 | $46.06 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.69 / $90.96 / $132.87
| Professional | TC | $61.69 | $90.96 | $132.87 |