- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.51 / $44.67 / $120.23
| Facility | 26 | $29.51 | $44.67 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $114.82 / $323.59
| Professional | | $89.13 | $114.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $42.66 / $97.72
| Professional | 26 | $28.18 | $42.66 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $77.62 / $151.36
| Professional | TC | $60.26 | $77.62 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Facility | 26 | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $120.23 / $229.09
| Professional | | $81.28 | $120.23 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $38.90 / $70.79
| Professional | 26 | $26.92 | $38.90 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $83.18 / $154.88
| Professional | TC | $58.88 | $83.18 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $43.65 / $104.71
| Facility | 26 | $8.13 | $43.65 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $144.54 / $288.40
| Professional | | $87.10 | $144.54 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $46.77 / $89.13
| Professional | 26 | $26.92 | $46.77 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $100.00 / $204.17
| Professional | TC | $60.26 | $100.00 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $218.78
| Professional | | $87.10 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.18 / $37.15 / $69.18
| Professional | 26 | $28.18 | $37.15 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $77.62 / $147.91
| Professional | TC | $58.88 | $77.62 | $147.91 |