- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $48.98 / $128.82
| Facility | 26 | $32.36 | $48.98 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $144.54 / $446.68
| Professional | | $72.44 | $144.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $61.66 / $162.18
| Professional | 26 | $32.36 | $61.66 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.02 / $56.23 / $138.04
| Professional | TC | $38.02 | $56.23 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | 26 | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $107.15 / $190.55
| Professional | | $79.43 | $107.15 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $45.71 / $79.43
| Professional | 26 | $34.67 | $45.71 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.71 / $61.66 / $114.82
| Professional | TC | $45.71 | $61.66 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $46.77 / $117.49
| Facility | 26 | $8.91 | $46.77 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $120.23 / $234.42
| Professional | | $70.79 | $120.23 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $51.29 / $97.72
| Professional | 26 | $30.90 | $51.29 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $40.74 / $70.79 / $134.90
| Professional | TC | $40.74 | $70.79 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $97.72 / $177.83
| Professional | | $70.79 | $97.72 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $40.74 / $75.86
| Professional | 26 | $30.90 | $40.74 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $54.95 / $100.00
| Professional | TC | $39.81 | $54.95 | $100.00 |