- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.36 / $32.36 / $104.24
| Facility | 26 | $30.36 | $32.36 | $104.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.54 / $157.09 / $211.67
| Professional | | $111.54 | $157.09 | $211.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $18.76 / $30.36 / $40.72
| Professional | 26 | $18.76 | $30.36 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.45 / $122.63 / $177.56
| Professional | TC | $90.45 | $122.63 | $177.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.94 / $158.61 / $198.16
| Professional | | $142.94 | $158.61 | $198.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.09 / $29.52 / $34.60
| Professional | 26 | $25.09 | $29.52 | $34.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $112.06 / $125.27 / $170.75
| Professional | TC | $112.06 | $125.27 | $170.75 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.52 / $21.52 / $23.05
| Professional | 26 | $21.52 | $21.52 | $23.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.37 / $142.24 / $221.98
| Professional | | $112.37 | $142.24 | $221.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.28 / $26.80 / $43.50
| Professional | 26 | $22.28 | $26.80 | $43.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $89.54 / $116.95 / $194.71
| Professional | TC | $89.54 | $116.95 | $194.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.82 / $141.36 / $240.41
| Professional | | $107.82 | $141.36 | $240.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.68 / $25.98 / $46.66
| Professional | 26 | $19.68 | $25.98 | $46.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $84.70 / $117.72 / $187.15
| Professional | TC | $84.70 | $117.72 | $187.15 |