- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $64.37 / $64.38 / $64.38
| Facility | 26 | $64.37 | $64.38 | $64.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.97 / $168.69 / $275.00
| Professional | | $145.97 | $168.69 | $275.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $42.14 / $55.00 / $70.79
| Professional | 26 | $42.14 | $55.00 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.82 / $104.31 / $220.00
| Professional | TC | $103.82 | $104.31 | $220.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $49.79 / $64.31 / $80.80
| Professional | 26 | $49.79 | $64.31 | $80.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.37 / $74.39 / $159.61
| Professional | | $49.37 | $74.39 | $159.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.72 / $47.56 / $56.12
| Professional | 26 | $34.72 | $47.56 | $56.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.01 / $48.24 / $103.49
| Professional | TC | $32.01 | $48.24 | $103.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.87 / $209.09 / $385.00
| Professional | | $104.87 | $209.09 | $385.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.65 / $57.13 / $133.37
| Professional | 26 | $34.65 | $57.13 | $133.37 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $68.59 / $121.77 / $257.08
| Professional | TC | $68.59 | $121.77 | $257.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.16 / $146.88 / $253.44
| Professional | | $110.16 | $146.88 | $253.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.08 / $47.55 / $66.69
| Professional | 26 | $37.08 | $47.55 | $66.69 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $73.08 / $99.45 / $193.64
| Professional | TC | $73.08 | $99.45 | $193.64 |