- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.29 / $35.53 / $96.54
| Facility | 26 | $32.29 | $35.53 | $96.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.71 / $135.26 / $213.57
| Professional | | $96.71 | $135.26 | $213.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $29.32 / $35.53 / $70.18
| Professional | 26 | $29.32 | $35.53 | $70.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $64.42 / $83.28 / $139.25
| Professional | TC | $64.42 | $83.28 | $139.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.70 / $91.39 / $211.89
| Professional | | $36.70 | $91.39 | $211.89 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.07 / $37.07 / $37.07
| Facility | 26 | $37.07 | $37.07 | $37.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.00 / $137.09 / $291.56
| Professional | | $85.00 | $137.09 | $291.56 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.60 / $44.92 / $101.29
| Professional | 26 | $26.60 | $44.92 | $101.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.81 / $90.69 / $191.78
| Professional | TC | $58.81 | $90.69 | $191.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.61 / $182.33 / $283.31
| Professional | | $178.61 | $182.33 | $283.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $50.99 / $56.08 / $86.53
| Professional | 26 | $50.99 | $56.08 | $86.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $119.02 / $126.01 / $134.94
| Professional | TC | $119.02 | $126.01 | $134.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.70 / $111.52 / $197.62
| Professional | | $84.70 | $111.52 | $197.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.11 / $35.25 / $72.84
| Professional | 26 | $23.11 | $35.25 | $72.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $53.69 / $75.84 / $153.02
| Professional | TC | $53.69 | $75.84 | $153.02 |