- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.48 / $41.88 / $66.81
| Facility | 26 | $31.48 | $41.88 | $66.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.12 / $129.16 / $418.83
| Professional | | $92.12 | $129.16 | $418.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.39 / $39.70 / $127.88
| Professional | 26 | $29.39 | $39.70 | $127.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.24 / $91.68 / $184.74
| Professional | TC | $63.24 | $91.68 | $184.74 |
- 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
- $99.75 / $123.73 / $202.34
| Professional | | $99.75 | $123.73 | $202.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.59 / $41.53 / $64.03
| Professional | 26 | $31.59 | $41.53 | $64.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.76 / $83.14 / $143.42
| Professional | TC | $66.76 | $83.14 | $143.42 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.07 / $37.07 / $37.07
| Facility | 26 | $37.07 | $37.07 | $37.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.18 / $144.13 / $244.26
| Professional | | $94.18 | $144.13 | $244.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.81 / $45.07 / $76.48
| Professional | 26 | $28.81 | $45.07 | $76.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $62.28 / $100.09 / $168.04
| Professional | TC | $62.28 | $100.09 | $168.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.10 / $122.67 / $217.46
| Professional | | $100.10 | $122.67 | $217.46 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.51 / $39.56 / $74.41
| Professional | 26 | $31.51 | $39.56 | $74.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.95 / $85.12 / $150.52
| Professional | TC | $65.95 | $85.12 | $150.52 |