- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $28.18 / $38.02
| Facility | 26 | $21.38 | $28.18 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $208.93 / $338.84
| Professional | | $186.21 | $208.93 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.95 / $26.92 / $51.29
| Professional | 26 | $19.95 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $162.18 / $190.55 / $309.03
| Professional | TC | $162.18 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $21.88 / $32.36
| Professional | 26 | $17.38 | $21.88 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $213.80 / $354.81
| Professional | | $208.93 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $22.91 / $35.48
| Professional | 26 | $21.38 | $22.91 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $190.55 / $190.55 / $316.23
| Professional | TC | $190.55 | $190.55 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $489.78
| Professional | | $263.03 | $309.03 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $30.90 / $51.29
| Professional | 26 | $26.92 | $30.90 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $234.42 / $275.42 / $436.52
| Professional | TC | $234.42 | $275.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $263.03 / $416.87
| Professional | | $213.80 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $26.92 / $43.65
| Professional | 26 | $21.88 | $26.92 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $194.98 / $234.42 / $380.19
| Professional | TC | $194.98 | $234.42 | $380.19 |