- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.59 / $34.96 / $48.00
| Facility | 26 | $29.59 | $34.96 | $48.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.92 / $115.19 / $178.06
| Professional | | $87.92 | $115.19 | $178.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.82 / $33.06 / $44.16
| Professional | 26 | $23.82 | $33.06 | $44.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.09 / $82.51 / $133.91
| Professional | TC | $64.09 | $82.51 | $133.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.84 / $78.84 / $102.02
| Professional | | $78.84 | $78.84 | $102.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.59 / $27.16 / $31.23
| Professional | 26 | $26.59 | $27.16 | $31.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.94 / $127.25 / $191.32
| Professional | | $106.94 | $127.25 | $191.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.81 / $36.54 / $54.94
| Professional | 26 | $31.81 | $36.54 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.13 / $90.71 / $138.50
| Professional | TC | $75.13 | $90.71 | $138.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.94 / $28.66 / $68.95
| Professional | 26 | $25.94 | $28.66 | $68.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.69 / $102.05 / $175.53
| Professional | | $61.69 | $102.05 | $175.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.68 / $28.80 / $53.18
| Professional | 26 | $17.68 | $28.80 | $53.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $44.01 / $71.34 / $127.56
| Professional | TC | $44.01 | $71.34 | $127.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.59 / $109.71 / $181.01
| Professional | | $79.59 | $109.71 | $181.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.97 / $31.23 / $53.77
| Professional | 26 | $21.97 | $31.23 | $53.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.73 / $75.50 / $120.59
| Professional | TC | $55.73 | $75.50 | $120.59 |