- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.10 / $50.00 / $56.60
| Facility | 26 | $39.10 | $50.00 | $56.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.04 / $129.02 / $202.59
| Professional | | $101.04 | $129.02 | $202.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.91 / $45.40 / $61.90
| Professional | 26 | $29.91 | $45.40 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.95 / $84.01 / $143.43
| Professional | TC | $65.95 | $84.01 | $143.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.87 / $41.92 / $70.70
| Professional | 26 | $29.87 | $41.92 | $70.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.96 / $158.22 / $203.02
| Professional | | $139.96 | $158.22 | $203.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.64 / $55.52 / $65.18
| Professional | 26 | $44.64 | $55.52 | $65.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $92.82 / $105.82 / $144.82
| Professional | TC | $92.82 | $105.82 | $144.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.82 / $34.82 / $37.27
| Professional | 26 | $34.82 | $34.82 | $37.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.76 / $116.63 / $212.81
| Professional | | $70.76 | $116.63 | $212.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.74 / $39.63 / $71.14
| Professional | 26 | $23.74 | $39.63 | $71.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.02 / $79.44 / $141.41
| Professional | TC | $47.02 | $79.44 | $141.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.48 / $122.50 / $182.25
| Professional | | $83.48 | $122.50 | $182.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.05 / $41.65 / $62.45
| Professional | 26 | $29.05 | $41.65 | $62.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.73 / $80.84 / $122.78
| Professional | TC | $55.73 | $80.84 | $122.78 |