- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.65 / $26.65 / $27.19
| Facility | 26 | $26.65 | $26.65 | $27.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.73 / $111.42 / $163.50
| Professional | | $90.73 | $111.42 | $163.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.41 / $24.26 / $31.92
| Professional | 26 | $22.41 | $24.26 | $31.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.45 / $86.58 / $131.59
| Professional | TC | $66.45 | $86.58 | $131.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.00 / $551.00 / $551.00
| Professional | | $336.00 | $551.00 | $551.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $71.00 / $116.00 / $116.00
| Professional | 26 | $71.00 | $116.00 | $116.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $265.00 / $435.00 / $435.00
| Professional | TC | $265.00 | $435.00 | $435.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.02 / $144.57 / $286.42
| Professional | | $95.02 | $144.57 | $286.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.20 / $44.04 / $77.84
| Professional | 26 | $30.20 | $44.04 | $77.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.81 / $111.03 / $206.90
| Professional | TC | $64.81 | $111.03 | $206.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.91 / $219.93 / $326.70
| Professional | | $100.91 | $219.93 | $326.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.20 / $53.25 / $90.96
| Professional | 26 | $28.20 | $53.25 | $90.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.81 / $183.18 / $204.65
| Professional | TC | $74.81 | $183.18 | $204.65 |