- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.35 / $33.35 / $33.35
| Facility | 26 | $33.35 | $33.35 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.32 / $65.63 / $88.23
| Professional | | $56.32 | $65.63 | $88.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.38 / $30.54 / $65.83
| Professional | 26 | $25.38 | $30.54 | $65.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.94 / $35.18 / $48.09
| Professional | TC | $30.94 | $35.18 | $48.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.67 / $78.05 / $116.13
| Professional | | $63.67 | $78.05 | $116.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.45 / $39.11 / $56.17
| Professional | 26 | $29.45 | $39.11 | $56.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.83 / $41.25 / $64.70
| Professional | TC | $33.83 | $41.25 | $64.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.04 / $36.68 / $66.17
| Professional | | $25.04 | $36.68 | $66.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $481.30 / $481.30 / $481.30
| Facility | 26 | $481.30 | $481.30 | $481.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.45 / $92.88 / $130.59
| Professional | | $69.45 | $92.88 | $130.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.99 / $40.29 / $65.94
| Professional | 26 | $30.99 | $40.29 | $65.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.15 / $48.60 / $67.05
| Professional | TC | $38.15 | $48.60 | $67.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.22 / $65.13 / $100.20
| Professional | | $50.22 | $65.13 | $100.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.26 / $30.78 / $47.79
| Professional | 26 | $24.26 | $30.78 | $47.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.66 / $34.86 / $51.60
| Professional | TC | $26.66 | $34.86 | $51.60 |