- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.93 / $145.54 / $213.85
| Facility | 26 | $34.93 | $145.54 | $213.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.59 / $138.22 / $399.66
| Professional | | $82.59 | $138.22 | $399.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.36 / $55.59 / $135.00
| Professional | 26 | $30.36 | $55.59 | $135.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.14 / $68.44 / $286.00
| Professional | TC | $51.14 | $68.44 | $286.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.16 / $111.37 / $165.62
| Professional | | $81.16 | $111.37 | $165.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.86 / $43.47 / $65.76
| Professional | 26 | $32.86 | $43.47 | $65.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.10 / $67.91 / $103.71
| Professional | TC | $55.10 | $67.91 | $103.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.96 / $37.11 / $98.49
| Professional | | $24.96 | $37.11 | $98.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $198.33 / $198.33 / $198.33
| Facility | 26 | $198.33 | $198.33 | $198.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.46 / $140.58 / $173.71
| Professional | | $120.46 | $140.58 | $173.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $45.11 / $57.26 / $71.59
| Professional | 26 | $45.11 | $57.26 | $71.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $75.34 / $94.39 / $112.43
| Professional | TC | $75.34 | $94.39 | $112.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.25 / $86.85 / $141.12
| Professional | | $81.25 | $86.85 | $141.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.54 / $33.20 / $53.55
| Professional | 26 | $31.54 | $33.20 | $53.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.50 / $52.33 / $86.34
| Professional | TC | $51.50 | $52.33 | $86.34 |