- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $33.88 / $91.20
| Facility | 26 | $22.91 | $33.88 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $120.23 / $389.05
| Professional | | $81.28 | $120.23 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $34.67 / $91.20
| Professional | 26 | $21.88 | $34.67 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.23 / $79.43 / $181.97
| Professional | TC | $56.23 | $79.43 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Facility | 26 | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $117.49 / $223.87
| Professional | | $85.11 | $117.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $31.62 / $61.66
| Professional | 26 | $24.55 | $31.62 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.88 / $91.20 / $169.82
| Professional | TC | $58.88 | $91.20 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.31 / $33.88 / $81.28
| Facility | 26 | $6.31 | $33.88 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $134.90 / $275.42
| Professional | | $83.18 | $134.90 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $36.31 / $69.18
| Professional | 26 | $21.88 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $100.00 / $213.80
| Professional | TC | $61.66 | $100.00 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $114.82 / $213.80
| Professional | | $85.11 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $30.20 / $53.70
| Professional | 26 | $22.39 | $30.20 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $87.10 / $162.18
| Professional | TC | $61.66 | $87.10 | $162.18 |