- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.60 / $38.29 / $62.90
| Facility | 26 | $28.60 | $38.29 | $62.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.51 / $99.77 / $300.00
| Professional | | $66.51 | $99.77 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.03 / $29.82 / $61.37
| Professional | 26 | $24.03 | $29.82 | $61.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.50 / $72.05 / $155.32
| Professional | TC | $42.50 | $72.05 | $155.32 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.40 / $30.40 / $30.40
| Facility | 26 | $30.40 | $30.40 | $30.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.81 / $117.54 / $211.48
| Professional | | $74.81 | $117.54 | $211.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.52 / $33.74 / $57.79
| Professional | 26 | $26.52 | $33.74 | $57.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.66 / $84.56 / $143.26
| Professional | TC | $47.66 | $84.56 | $143.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Facility | 26 | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.94 / $138.13 / $248.05
| Professional | | $86.94 | $138.13 | $248.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.27 / $38.07 / $64.08
| Professional | 26 | $24.27 | $38.07 | $64.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.58 / $98.20 / $175.49
| Professional | TC | $61.58 | $98.20 | $175.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.86 / $117.07 / $212.96
| Professional | | $85.86 | $117.07 | $212.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.81 / $33.61 / $59.08
| Professional | 26 | $24.81 | $33.61 | $59.08 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.46 / $87.00 / $155.15
| Professional | TC | $60.46 | $87.00 | $155.15 |