- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.92 / $49.91 / $94.91
| Facility | 26 | $36.92 | $49.91 | $94.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.19 / $123.08 / $336.30
| Professional | | $110.19 | $123.08 | $336.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.43 / $36.92 / $57.14
| Professional | 26 | $34.43 | $36.92 | $57.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.76 / $87.07 / $107.16
| Professional | TC | $75.76 | $87.07 | $107.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.63 / $149.60 / $224.92
| Professional | | $93.63 | $149.60 | $224.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.81 / $43.36 / $68.78
| Professional | 26 | $26.81 | $43.36 | $68.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.81 / $106.25 / $160.44
| Professional | TC | $66.81 | $106.25 | $160.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.45 / $175.45 / $175.45
| Professional | | $175.45 | $175.45 | $175.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.08 / $38.31 / $48.07
| Professional | 26 | $38.08 | $38.31 | $48.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.25 / $157.72 / $305.47
| Professional | | $101.25 | $157.72 | $305.47 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.40 / $45.40 / $91.52
| Professional | 26 | $30.40 | $45.40 | $91.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.65 / $107.21 / $208.81
| Professional | TC | $75.65 | $107.21 | $208.81 |