- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.93 / $40.93 / $56.33
| Facility | 26 | $40.93 | $40.93 | $56.33 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $74.06 / $279.04 / $523.80
| Facility | TC | $74.06 | $279.04 | $523.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.39 / $42.06 / $126.66
| Professional | | $35.39 | $42.06 | $126.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.53 / $14.49 / $49.76
| Professional | 26 | $12.53 | $14.49 | $49.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.85 / $27.56 / $81.59
| Professional | TC | $22.85 | $27.56 | $81.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.30 / $102.06 / $149.76
| Professional | | $63.30 | $102.06 | $149.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.63 / $42.95 / $48.23
| Professional | 26 | $19.63 | $42.95 | $48.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.67 / $59.12 / $105.61
| Professional | TC | $43.67 | $59.12 | $105.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.90 / $122.28 / $265.87
| Professional | | $101.90 | $122.28 | $265.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.55 / $38.57 / $112.78
| Professional | 26 | $31.55 | $38.57 | $112.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.06 / $84.42 / $201.44
| Professional | TC | $65.06 | $84.42 | $201.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.00 / $171.45 / $259.26
| Professional | | $140.00 | $171.45 | $259.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.75 / $52.65 / $87.17
| Professional | 26 | $48.75 | $52.65 | $87.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $90.00 / $118.80 / $172.10
| Professional | TC | $90.00 | $118.80 | $172.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.65 / $140.00 / $251.35
| Professional | | $54.65 | $140.00 | $251.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.00 / $58.50 / $87.17
| Professional | 26 | $40.00 | $58.50 | $87.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.00 / $115.50 / $172.10
| Professional | TC | $70.00 | $115.50 | $172.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.37 / $109.13 / $252.39
| Professional | | $58.37 | $109.13 | $252.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.11 / $40.15 / $96.98
| Professional | 26 | $20.11 | $40.15 | $96.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.65 / $75.61 / $154.00
| Professional | TC | $39.65 | $75.61 | $154.00 |