- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.99 / $47.67 / $86.01
| Facility | 26 | $38.99 | $47.67 | $86.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.43 / $137.64 / $455.61
| Professional | | $93.43 | $137.64 | $455.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.53 / $51.45 / $192.00
| Professional | 26 | $36.53 | $51.45 | $192.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.82 / $69.69 / $128.80
| Professional | TC | $56.82 | $69.69 | $128.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.38 / $47.38 / $47.38
| Facility | 26 | $47.38 | $47.38 | $47.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.21 / $127.50 / $209.85
| Professional | | $99.21 | $127.50 | $209.85 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.79 / $50.56 / $79.46
| Professional | 26 | $37.79 | $50.56 | $79.46 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $62.43 / $79.27 / $129.58
| Professional | TC | $62.43 | $79.27 | $129.58 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.25 / $46.25 / $46.25
| Facility | 26 | $46.25 | $46.25 | $46.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.24 / $141.25 / $247.50
| Professional | | $93.24 | $141.25 | $247.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.03 / $55.34 / $93.21
| Professional | 26 | $36.03 | $55.34 | $93.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.08 / $87.68 / $156.19
| Professional | TC | $54.08 | $87.68 | $156.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.92 / $121.85 / $220.25
| Professional | | $96.92 | $121.85 | $220.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.97 / $47.94 / $81.30
| Professional | 26 | $38.97 | $47.94 | $81.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.51 / $75.62 / $132.81
| Professional | TC | $58.51 | $75.62 | $132.81 |