- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.37 / $55.72 / $117.71
| Facility | 26 | $42.37 | $55.72 | $117.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.66 / $180.79 / $399.63
| Professional | | $106.66 | $180.79 | $399.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.46 / $44.84 / $123.00
| Professional | 26 | $36.46 | $44.84 | $123.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.47 / $135.43 / $242.00
| Professional | TC | $67.47 | $135.43 | $242.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.38 / $45.38 / $45.38
| Facility | 26 | $45.38 | $45.38 | $45.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.28 / $157.69 / $353.09
| Professional | | $106.28 | $157.69 | $353.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.21 / $54.72 / $87.25
| Professional | 26 | $39.21 | $54.72 | $87.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.83 / $111.33 / $270.02
| Professional | TC | $68.83 | $111.33 | $270.02 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.92 / $45.92 / $45.92
| Facility | 26 | $45.92 | $45.92 | $45.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.10 / $215.49 / $352.97
| Professional | | $106.10 | $215.49 | $352.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.97 / $57.53 / $100.01
| Professional | 26 | $35.97 | $57.53 | $100.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $67.30 / $140.00 / $262.64
| Professional | TC | $67.30 | $140.00 | $262.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.09 / $175.01 / $296.94
| Professional | | $104.09 | $175.01 | $296.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.11 / $49.48 / $92.33
| Professional | 26 | $37.11 | $49.48 | $92.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.29 / $110.43 / $216.14
| Professional | TC | $65.29 | $110.43 | $216.14 |