- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.59 / $51.59 / $69.64
| Facility | 26 | $51.59 | $51.59 | $69.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.86 / $133.54 / $182.36
| Professional | | $103.86 | $133.54 | $182.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.04 / $41.89 / $59.49
| Professional | 26 | $33.04 | $41.89 | $59.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.81 / $91.66 / $122.88
| Professional | TC | $70.81 | $91.66 | $122.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.05 / $92.51 / $111.31
| Professional | | $82.05 | $92.51 | $111.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.08 / $39.40 / $46.51
| Professional | 26 | $28.08 | $39.40 | $46.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.07 / $159.00 / $187.62
| Professional | | $116.07 | $159.00 | $187.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.86 / $50.50 / $59.59
| Professional | 26 | $36.86 | $50.50 | $59.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.20 / $108.50 / $128.03
| Professional | TC | $79.20 | $108.50 | $128.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.06 / $140.10 / $238.10
| Professional | | $87.06 | $140.10 | $238.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.89 / $49.25 / $75.98
| Professional | 26 | $30.89 | $49.25 | $75.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $66.31 / $106.28 / $180.91
| Professional | TC | $66.31 | $106.28 | $180.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.32 / $133.81 / $181.72
| Professional | | $102.32 | $133.81 | $181.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.40 / $40.93 / $53.64
| Professional | 26 | $31.40 | $40.93 | $53.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.92 / $87.00 / $125.21
| Professional | TC | $70.92 | $87.00 | $125.21 |