- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.60 / $22.37 / $124.33
| Facility | 26 | $18.60 | $22.37 | $124.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.55 / $130.49 / $143.77
| Professional | | $88.55 | $130.49 | $143.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $73.16 / $108.34 / $120.63
| Professional | TC | $73.16 | $108.34 | $120.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.10 / $66.44 / $176.86
| Professional | | $23.10 | $66.44 | $176.86 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.75 / $22.75 / $36.06
| Facility | 26 | $22.75 | $22.75 | $36.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.53 / $113.08 / $176.94
| Professional | | $90.53 | $113.08 | $176.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.06 / $90.52 / $145.62
| Professional | TC | $68.06 | $90.52 | $145.62 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.81 / $104.46 / $104.46
| Facility | 26 | $54.81 | $104.46 | $104.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.67 / $136.16 / $923.37
| Professional | | $105.67 | $136.16 | $923.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $79.36 / $102.17 / $778.42
| Professional | TC | $79.36 | $102.17 | $778.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.32 / $118.88 / $198.66
| Professional | | $94.32 | $118.88 | $198.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $74.11 / $96.79 / $161.33
| Professional | TC | $74.11 | $96.79 | $161.33 |