- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.35 / $33.88 / $73.94
| Facility | 26 | $27.35 | $33.88 | $73.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.42 / $57.49 / $134.72
| Professional | | $46.42 | $57.49 | $134.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.77 / $32.58 / $79.89
| Professional | 26 | $25.77 | $32.58 | $79.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $27.50 / $57.49 / $222.00
| Professional | 52 | $27.50 | $57.49 | $222.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.65 / $25.33 / $57.87
| Professional | TC | $20.65 | $25.33 | $57.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.26 / $37.26 / $37.26
| Facility | 26 | $37.26 | $37.26 | $37.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.09 / $61.94 / $107.31
| Professional | | $50.09 | $61.94 | $107.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.60 / $34.90 / $58.81
| Professional | 26 | $27.60 | $34.90 | $58.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.97 / $27.52 / $46.52
| Professional | TC | $22.97 | $27.52 | $46.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $32.40 / $32.40
| Facility | 26 | $32.40 | $32.40 | $32.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.03 / $72.63 / $118.14
| Professional | | $48.03 | $72.63 | $118.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.49 / $40.82 / $65.93
| Professional | 26 | $25.49 | $40.82 | $65.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.21 / $33.34 / $55.30
| Professional | TC | $22.21 | $33.34 | $55.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.23 / $68.01 / $114.26
| Professional | | $52.23 | $68.01 | $114.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.41 / $36.70 / $63.00
| Professional | 26 | $28.41 | $36.70 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.92 / $29.66 / $48.89
| Professional | TC | $22.92 | $29.66 | $48.89 |