- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.64 / $39.89 / $74.77
| Facility | 26 | $29.64 | $39.89 | $74.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.67 / $116.67 / $380.00
| Professional | | $74.67 | $116.67 | $380.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.64 / $46.37 / $125.14
| Professional | 26 | $27.64 | $46.37 | $125.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.68 / $61.17 / $117.35
| Professional | TC | $43.68 | $61.17 | $117.35 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.01 / $35.01 / $35.01
| Facility | 26 | $35.01 | $35.01 | $35.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.47 / $100.63 / $162.04
| Professional | | $77.47 | $100.63 | $162.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.17 / $41.34 / $61.90
| Professional | 26 | $30.17 | $41.34 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.26 / $61.27 / $100.13
| Professional | TC | $48.26 | $61.27 | $100.13 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.11 / $35.11 / $35.11
| Facility | 26 | $35.11 | $35.11 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.65 / $110.77 / $189.74
| Professional | | $73.65 | $110.77 | $189.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.31 / $42.67 / $69.73
| Professional | 26 | $28.31 | $42.67 | $69.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.39 / $69.04 / $119.99
| Professional | TC | $46.39 | $69.04 | $119.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.98 / $94.87 / $165.51
| Professional | | $77.98 | $94.87 | $165.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.38 / $36.03 / $62.55
| Professional | 26 | $29.38 | $36.03 | $62.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.53 / $59.51 / $102.73
| Professional | TC | $47.53 | $59.51 | $102.73 |