- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.04 / $61.27 / $61.43
| Facility | 26 | $12.04 | $61.27 | $61.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.17 / $41.82 / $195.00
| Professional | | $34.17 | $41.82 | $195.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.99 / $12.04 / $26.74
| Professional | 26 | $8.99 | $12.04 | $26.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.57 / $29.05 / $56.27
| Professional | TC | $24.57 | $29.05 | $56.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.25 / $47.81 / $84.08
| Professional | | $37.25 | $47.81 | $84.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.42 / $14.51 / $23.45
| Professional | 26 | $11.42 | $14.51 | $23.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.24 / $33.97 / $60.63
| Professional | TC | $25.24 | $33.97 | $60.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $28.95 / $39.23
| Professional | | $22.10 | $28.95 | $39.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.00 / $65.55 / $78.39
| Professional | | $59.00 | $65.55 | $78.39 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.87 / $19.87 / $23.29
| Professional | 26 | $15.87 | $19.87 | $23.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.13 / $45.88 / $55.76
| Professional | TC | $43.13 | $45.88 | $55.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.08 / $38.97 / $64.81
| Professional | | $35.08 | $38.97 | $64.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.55 / $11.91 / $19.64
| Professional | 26 | $10.55 | $11.91 | $19.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.72 / $27.22 / $45.00
| Professional | TC | $25.72 | $27.22 | $45.00 |