- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.67 / $45.39 / $80.08
| Facility | 26 | $36.67 | $45.39 | $80.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.04 / $119.68 / $224.91
| Professional | | $101.04 | $119.68 | $224.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.91 / $39.04 / $97.85
| Professional | 26 | $29.91 | $39.04 | $97.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.66 / $81.69 / $143.43
| Professional | TC | $68.66 | $81.69 | $143.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.81 / $36.81 / $36.81
| Facility | 26 | $36.81 | $36.81 | $36.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.77 / $137.00 / $225.06
| Professional | | $100.77 | $137.00 | $225.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.34 / $45.10 / $71.92
| Professional | 26 | $34.34 | $45.10 | $71.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.09 / $92.57 / $156.91
| Professional | TC | $72.09 | $92.57 | $156.91 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $43.57 / $43.57 / $43.57
| Facility | 26 | $43.57 | $43.57 | $43.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.96 / $149.08 / $273.00
| Professional | | $97.96 | $149.08 | $273.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.27 / $49.56 / $83.52
| Professional | 26 | $33.27 | $49.56 | $83.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.43 / $100.46 / $182.25
| Professional | TC | $64.43 | $100.46 | $182.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.92 / $131.74 / $231.32
| Professional | | $97.92 | $131.74 | $231.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.32 / $45.43 / $78.84
| Professional | 26 | $33.32 | $45.43 | $78.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.26 / $86.60 / $156.88
| Professional | TC | $66.26 | $86.60 | $156.88 |