- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.37 / $26.37 / $26.87
| Facility | 26 | $26.37 | $26.37 | $26.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.52 / $70.02 / $126.92
| Professional | | $44.52 | $70.02 | $126.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.89 / $28.17 / $63.80
| Professional | 26 | $22.89 | $28.17 | $63.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.44 / $37.67 / $98.75
| Professional | TC | $22.44 | $37.67 | $98.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.00 / $248.00 / $248.00
| Professional | | $151.00 | $248.00 | $248.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.00 / $115.00 / $115.00
| Professional | 26 | $70.00 | $115.00 | $115.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $81.00 / $133.00 / $133.00
| Professional | TC | $81.00 | $133.00 | $133.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.59 / $109.20 / $171.56
| Professional | | $75.59 | $109.20 | $171.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.56 / $42.72 / $75.80
| Professional | 26 | $28.56 | $42.72 | $75.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.75 / $56.63 / $91.45
| Professional | TC | $37.75 | $56.63 | $91.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.96 / $115.63 / $362.99
| Professional | | $92.96 | $115.63 | $362.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.22 / $57.11 / $105.93
| Professional | 26 | $29.22 | $57.11 | $105.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.41 / $71.41 / $268.39
| Professional | TC | $50.41 | $71.41 | $268.39 |