- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.52 / $43.40 / $71.41
| Facility | 26 | $36.52 | $43.40 | $71.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.64 / $79.14 / $86.67
| Professional | | $70.64 | $79.14 | $86.67 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.80 / $30.67 / $38.07
| Professional | 26 | $29.80 | $30.67 | $38.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.69 / $46.62 / $49.35
| Professional | TC | $39.69 | $46.62 | $49.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.00 / $136.00 / $136.00
| Professional | | $136.00 | $136.00 | $136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.01 / $102.70 / $160.91
| Professional | | $59.01 | $102.70 | $160.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.26 / $41.89 / $62.92
| Professional | 26 | $27.26 | $41.89 | $62.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.11 / $59.58 / $94.34
| Professional | TC | $35.11 | $59.58 | $94.34 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.77 / $145.31 / $145.31
| Facility | 26 | $74.77 | $145.31 | $145.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.00 / $121.83 / $583.91
| Professional | | $88.00 | $121.83 | $583.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $45.00 / $335.18
| Professional | 26 | $32.40 | $45.00 | $335.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.59 / $76.83 / $353.01
| Professional | TC | $55.59 | $76.83 | $353.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.00 / $105.81 / $160.34
| Professional | | $88.00 | $105.81 | $160.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.40 / $38.76 / $59.23
| Professional | 26 | $32.40 | $38.76 | $59.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.59 / $66.17 / $101.11
| Professional | TC | $55.59 | $66.17 | $101.11 |