- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.56 / $52.32 / $63.36
| Facility | 26 | $45.56 | $52.32 | $63.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.68 / $96.53 / $142.41
| Professional | | $68.68 | $96.53 | $142.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.86 / $52.32 / $70.59
| Professional | 26 | $33.86 | $52.32 | $70.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.82 / $44.21 / $73.13
| Professional | TC | $34.82 | $44.21 | $73.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.86 / $94.86 / $94.86
| Professional | | $94.86 | $94.86 | $94.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.88 / $101.04 / $142.31
| Professional | | $85.88 | $101.04 | $142.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.18 / $52.24 / $80.01
| Professional | 26 | $46.18 | $52.24 | $80.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.48 / $49.76 / $63.54
| Professional | TC | $41.48 | $49.76 | $63.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $43.51 / $43.51
| Professional | 26 | $40.00 | $43.51 | $43.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.54 / $96.61 / $150.18
| Professional | | $75.54 | $96.61 | $150.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.61 / $52.19 / $79.20
| Professional | 26 | $40.61 | $52.19 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.44 / $45.99 / $68.97
| Professional | TC | $29.44 | $45.99 | $68.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.69 / $87.70 / $149.84
| Professional | | $63.69 | $87.70 | $149.84 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.01 / $49.34 / $85.29
| Professional | 26 | $38.01 | $49.34 | $85.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.89 / $40.44 / $68.68
| Professional | TC | $28.89 | $40.44 | $68.68 |