- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.76 / $57.03 / $57.04
| Facility | 26 | $36.76 | $57.03 | $57.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.54 / $126.02 / $183.18
| Professional | | $105.54 | $126.02 | $183.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.91 / $38.85 / $57.04
| Professional | 26 | $29.91 | $38.85 | $57.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.62 / $86.26 / $126.13
| Professional | TC | $72.62 | $86.26 | $126.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.57 / $101.57 / $101.57
| Professional | | $101.57 | $101.57 | $101.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.08 / $35.85 / $51.48
| Professional | 26 | $31.08 | $35.85 | $51.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.70 / $143.41 / $169.24
| Professional | | $104.70 | $143.41 | $169.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.96 / $52.00 / $61.36
| Professional | 26 | $37.96 | $52.00 | $61.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.73 / $91.42 / $107.88
| Professional | TC | $66.73 | $91.42 | $107.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.43 / $38.43 / $38.77
| Facility | 26 | $38.43 | $38.43 | $38.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.77 / $150.61 / $337.76
| Professional | | $107.77 | $150.61 | $337.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.45 / $44.03 / $103.89
| Professional | 26 | $33.45 | $44.03 | $103.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $73.67 / $106.12 / $233.87
| Professional | TC | $73.67 | $106.12 | $233.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.18 / $128.34 / $168.04
| Professional | | $93.18 | $128.34 | $168.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.17 / $43.88 / $53.21
| Professional | 26 | $29.17 | $43.88 | $53.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.65 / $84.00 / $114.10
| Professional | TC | $65.65 | $84.00 | $114.10 |