- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $64.57 / $158.49
| Facility | 26 | $38.02 | $64.57 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $100.00 / $416.87
| Professional | | $70.79 | $100.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $48.98 / $147.91
| Professional | 26 | $35.48 | $48.98 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.36 / $51.29 / $218.78
| Professional | TC | $32.36 | $51.29 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $107.15 / $257.04
| Professional | | $52.48 | $107.15 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.51 / $47.86 / $89.13
| Professional | 26 | $29.51 | $47.86 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $57.54 / $173.78
| Professional | TC | $25.70 | $57.54 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.12 / $48.98 / $120.23
| Facility | 26 | $9.12 | $48.98 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $120.23 / $234.42
| Professional | | $63.10 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $53.70 / $102.33
| Professional | 26 | $30.90 | $53.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.51 / $64.57 / $154.88
| Professional | TC | $29.51 | $64.57 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $95.50 / $194.98
| Professional | | $61.66 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $42.66 / $81.28
| Professional | 26 | $32.36 | $42.66 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $45.71 / $120.23
| Professional | TC | $27.54 | $45.71 | $120.23 |