- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.98 / $48.09 / $56.49
| Facility | 26 | $45.98 | $48.09 | $56.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.86 / $140.97 / $200.60
| Professional | | $113.86 | $140.97 | $200.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.10 / $45.43 / $67.90
| Professional | 26 | $40.10 | $45.43 | $67.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.22 / $93.95 / $137.16
| Professional | TC | $72.22 | $93.95 | $137.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.68 / $138.38 / $229.64
| Professional | | $103.68 | $138.38 | $229.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.72 / $50.86 / $83.92
| Professional | 26 | $37.72 | $50.86 | $83.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.20 / $84.91 / $160.16
| Professional | TC | $63.20 | $84.91 | $160.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.38 / $50.38 / $50.38
| Facility | 26 | $50.38 | $50.38 | $50.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.02 / $192.11 / $337.62
| Professional | | $119.02 | $192.11 | $337.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.01 / $63.06 / $109.87
| Professional | 26 | $45.01 | $63.06 | $109.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.87 / $123.56 / $234.10
| Professional | TC | $72.87 | $123.56 | $234.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.31 / $160.11 / $287.22
| Professional | | $116.31 | $160.11 | $287.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.55 / $57.29 / $100.79
| Professional | 26 | $42.55 | $57.29 | $100.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $71.47 / $104.71 / $196.56
| Professional | TC | $71.47 | $104.71 | $196.56 |