- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.38 / $61.74 / $116.62
| Facility | 26 | $45.38 | $61.74 | $116.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.93 / $132.52 / $432.37
| Professional | | $118.93 | $132.52 | $432.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.60 / $45.38 / $125.46
| Professional | 26 | $42.60 | $45.38 | $125.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $83.71 / $87.95 / $109.93
| Professional | TC | $83.71 | $87.95 | $109.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.43 / $152.41 / $246.80
| Professional | | $101.43 | $152.41 | $246.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.21 / $50.96 / $84.52
| Professional | 26 | $34.21 | $50.96 | $84.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.03 / $101.46 / $162.27
| Professional | TC | $65.03 | $101.46 | $162.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.01 / $124.69 / $324.44
| Professional | | $124.01 | $124.69 | $324.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $42.66 / $59.45
| Professional | 26 | $42.66 | $42.66 | $59.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.26 / $91.26 / $92.40
| Professional | TC | $91.26 | $91.26 | $92.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.62 / $150.36 / $313.68
| Professional | | $117.62 | $150.36 | $313.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.26 / $56.33 / $111.22
| Professional | 26 | $39.26 | $56.33 | $111.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.88 / $100.35 / $202.46
| Professional | TC | $74.88 | $100.35 | $202.46 |