- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.21 / $40.49 / $52.57
| Facility | 26 | $39.21 | $40.49 | $52.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.43 / $107.60 / $286.75
| Professional | | $93.43 | $107.60 | $286.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.61 / $39.21 / $100.76
| Professional | 26 | $36.61 | $39.21 | $100.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.82 / $68.37 / $83.64
| Professional | TC | $56.82 | $68.37 | $83.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.25 / $110.84 / $200.38
| Professional | | $82.25 | $110.84 | $200.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.55 / $44.03 / $73.03
| Professional | 26 | $29.55 | $44.03 | $73.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.88 / $66.81 / $127.36
| Professional | TC | $48.88 | $66.81 | $127.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.55 / $100.55 / $151.22
| Professional | | $100.55 | $100.55 | $151.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.56 / $36.56 / $52.11
| Professional | 26 | $36.56 | $36.56 | $52.11 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.30 / $47.30 / $71.69
| Professional | TC | $47.30 | $47.30 | $71.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.96 / $123.13 / $253.27
| Professional | | $82.96 | $123.13 | $253.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.46 / $49.85 / $94.66
| Professional | 26 | $32.46 | $49.85 | $94.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.97 / $71.36 / $158.61
| Professional | TC | $43.97 | $71.36 | $158.61 |