- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $52.48 / $63.10
| Facility | 26 | $47.86 | $52.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $87.10 / $125.89
| Professional | | $69.18 | $87.10 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $44.67 / $63.10
| Professional | 26 | $36.31 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.88 / $41.69 / $58.88
| Professional | TC | $33.88 | $41.69 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $83.18 / $102.33
| Professional | | $74.13 | $83.18 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $100.00 / $112.20
| Professional | | $85.11 | $100.00 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.67 / $52.48 / $56.23
| Professional | 26 | $44.67 | $52.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $48.98 / $54.95
| Professional | TC | $39.81 | $48.98 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.81 / $39.81 / $43.65
| Professional | 26 | $39.81 | $39.81 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $165.96
| Professional | | $75.86 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.69 / $57.54 / $83.18
| Professional | 26 | $41.69 | $57.54 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $47.86 / $85.11
| Professional | TC | $31.62 | $47.86 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $85.11 / $144.54
| Professional | | $61.66 | $85.11 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $46.77 / $81.28
| Professional | 26 | $38.90 | $46.77 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $38.90 / $64.57
| Professional | TC | $27.54 | $38.90 | $64.57 |