- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.20 / $32.06 / $56.57
| Facility | 26 | $26.20 | $32.06 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.65 / $126.61 / $196.70
| Professional | | $101.65 | $126.61 | $196.70 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.74 / $30.91 / $47.17
| Professional | 26 | $23.74 | $30.91 | $47.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.04 / $100.23 / $151.91
| Professional | TC | $69.04 | $100.23 | $151.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.06 / $28.06 / $28.06
| Facility | 26 | $28.06 | $28.06 | $28.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.50 / $168.43 / $249.89
| Professional | | $110.50 | $168.43 | $249.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.15 / $35.57 / $57.28
| Professional | 26 | $25.15 | $35.57 | $57.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.64 / $141.19 / $203.47
| Professional | TC | $79.64 | $141.19 | $203.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.43 / $39.43 / $39.43
| Facility | 26 | $39.43 | $39.43 | $39.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.11 / $235.11 / $388.63
| Professional | | $155.11 | $235.11 | $388.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.88 / $39.36 / $64.54
| Professional | 26 | $26.88 | $39.36 | $64.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $126.18 / $196.70 / $321.45
| Professional | TC | $126.18 | $196.70 | $321.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.49 / $210.57 / $348.80
| Professional | | $152.49 | $210.57 | $348.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.87 / $36.65 / $57.08
| Professional | 26 | $25.87 | $36.65 | $57.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $127.62 / $177.68 / $299.29
| Professional | TC | $127.62 | $177.68 | $299.29 |