- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.35 / $45.52 / $85.73
| Facility | 26 | $33.35 | $45.52 | $85.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.70 / $101.41 / $291.83
| Professional | | $98.70 | $101.41 | $291.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.31 / $33.36 / $37.54
| Professional | 26 | $31.31 | $33.36 | $37.54 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $178.89 / $402.00 / $415.77
| Professional | 50 | $178.89 | $402.00 | $415.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $59.85 / $68.06 / $77.93
| Professional | TC | $59.85 | $68.06 | $77.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.56 / $121.58 / $187.79
| Professional | | $77.56 | $121.58 | $187.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.44 / $41.02 / $62.12
| Professional | 26 | $25.44 | $41.02 | $62.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.87 / $80.56 / $126.08
| Professional | TC | $52.87 | $80.56 | $126.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.30 / $103.32 / $140.15
| Professional | | $101.30 | $103.32 | $140.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.82 / $54.80 / $65.76
| Professional | 26 | $50.82 | $54.80 | $65.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $151.94 / $151.94 / $151.94
| Professional | 50 | $151.94 | $151.94 | $151.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.04 / $135.05 / $239.86
| Professional | | $90.04 | $135.05 | $239.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.64 / $40.89 / $81.25
| Professional | 26 | $28.64 | $40.89 | $81.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.66 / $77.75 / $158.61
| Professional | TC | $58.66 | $77.75 | $158.61 |