- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.56 / $45.21 / $75.14
| Facility | 26 | $34.56 | $45.21 | $75.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.76 / $135.45 / $446.00
| Professional | | $84.76 | $135.45 | $446.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.13 / $49.11 / $129.60
| Professional | 26 | $32.13 | $49.11 | $129.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.30 / $64.31 / $137.17
| Professional | TC | $49.30 | $64.31 | $137.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.69 / $40.69 / $40.69
| Facility | 26 | $40.69 | $40.69 | $40.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.58 / $110.11 / $179.24
| Professional | | $88.58 | $110.11 | $179.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.49 / $46.16 / $69.92
| Professional | 26 | $34.49 | $46.16 | $69.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.86 / $67.10 / $110.94
| Professional | TC | $52.86 | $67.10 | $110.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.86 / $40.86 / $40.86
| Facility | 26 | $40.86 | $40.86 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.35 / $124.94 / $212.45
| Professional | | $83.35 | $124.94 | $212.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.79 / $49.36 / $81.78
| Professional | 26 | $32.79 | $49.36 | $81.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.49 / $78.14 / $131.37
| Professional | TC | $51.49 | $78.14 | $131.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $107.18 / $184.29
| Professional | | $89.34 | $107.18 | $184.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.43 / $43.02 / $83.86
| Professional | 26 | $34.43 | $43.02 | $83.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.77 / $66.97 / $120.88
| Professional | TC | $53.77 | $66.97 | $120.88 |