- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.62 / $49.27 / $55.17
| Facility | 26 | $47.62 | $49.27 | $55.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.35 / $133.56 / $241.80
| Professional | | $100.35 | $133.56 | $241.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.04 / $47.85 / $66.64
| Professional | 26 | $33.04 | $47.85 | $66.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.99 / $79.79 / $159.16
| Professional | TC | $61.99 | $79.79 | $159.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.28 / $163.49 / $189.62
| Professional | | $139.28 | $163.49 | $189.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.09 / $47.62 / $70.61
| Professional | 26 | $44.09 | $47.62 | $70.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $77.91 / $119.27 / $138.44
| Professional | TC | $77.91 | $119.27 | $138.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.05 / $58.10 / $58.10
| Professional | 26 | $41.05 | $58.10 | $58.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.62 / $147.26 / $225.62
| Professional | | $104.62 | $147.26 | $225.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.61 / $50.10 / $78.59
| Professional | 26 | $36.61 | $50.10 | $78.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.02 / $98.14 / $148.38
| Professional | TC | $61.02 | $98.14 | $148.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.80 / $105.74 / $171.86
| Professional | | $80.80 | $105.74 | $171.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.43 / $44.03 / $67.59
| Professional | 26 | $32.43 | $44.03 | $67.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.41 / $65.26 / $114.18
| Professional | TC | $50.41 | $65.26 | $114.18 |