- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.97 / $47.89 / $92.63
| Facility | 26 | $39.97 | $47.89 | $92.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.14 / $130.41 / $242.46
| Professional | | $109.14 | $130.41 | $242.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.91 / $41.08 / $88.18
| Professional | 26 | $29.91 | $41.08 | $88.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.23 / $91.98 / $163.71
| Professional | TC | $79.23 | $91.98 | $163.71 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.81 / $36.81 / $36.81
| Facility | 26 | $36.81 | $36.81 | $36.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.00 / $152.69 / $252.53
| Professional | | $113.00 | $152.69 | $252.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.08 / $46.27 / $76.46
| Professional | 26 | $36.08 | $46.27 | $76.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.04 / $106.47 / $177.35
| Professional | TC | $81.04 | $106.47 | $177.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.64 / $48.64 / $48.64
| Facility | 26 | $48.64 | $48.64 | $48.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.25 / $166.87 / $299.91
| Professional | | $109.25 | $166.87 | $299.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.57 / $51.14 / $90.68
| Professional | 26 | $34.57 | $51.14 | $90.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.33 / $118.59 / $212.11
| Professional | TC | $75.33 | $118.59 | $212.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.42 / $145.41 / $288.29
| Professional | | $111.42 | $145.41 | $288.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.32 / $47.53 / $87.76
| Professional | 26 | $33.32 | $47.53 | $87.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $76.97 / $101.61 / $185.48
| Professional | TC | $76.97 | $101.61 | $185.48 |