- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.64 / $58.90 / $87.41
| Facility | 26 | $48.64 | $58.90 | $87.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.28 / $105.29 / $205.64
| Professional | | $85.28 | $105.29 | $205.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.96 / $48.64 / $113.56
| Professional | 26 | $40.96 | $48.64 | $113.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.15 / $54.64 / $84.67
| Professional | TC | $39.15 | $54.64 | $84.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.92 / $131.38 / $222.55
| Professional | | $88.92 | $131.38 | $222.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $48.32 / $61.19 / $95.02
| Professional | 26 | $48.32 | $61.19 | $95.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.46 / $66.22 / $137.78
| Professional | TC | $42.46 | $66.22 | $137.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.93 / $56.93 / $56.93
| Facility | 26 | $56.93 | $56.93 | $56.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.70 / $150.22 / $274.89
| Professional | | $101.70 | $150.22 | $274.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $47.26 / $68.53 / $114.47
| Professional | 26 | $47.26 | $68.53 | $114.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.35 / $74.04 / $149.87
| Professional | TC | $45.35 | $74.04 | $149.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.20 / $133.29 / $238.29
| Professional | | $94.20 | $133.29 | $238.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.45 / $62.41 / $104.01
| Professional | 26 | $46.45 | $62.41 | $104.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.03 / $65.69 / $134.06
| Professional | TC | $43.03 | $65.69 | $134.06 |