- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.27 / $11.48 / $46.55
| Facility | 26 | $11.27 | $11.48 | $46.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.26 / $101.67 / $114.92
| Professional | | $83.26 | $101.67 | $114.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.05 / $13.32 / $26.40
| Professional | 26 | $11.05 | $13.32 | $26.40 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.20 / $90.19 / $99.05
| Professional | TC | $72.20 | $90.19 | $99.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.00 / $442.00 / $442.00
| Professional | | $269.00 | $442.00 | $442.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.00 / $49.00 / $49.00
| Professional | 26 | $30.00 | $49.00 | $49.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $239.00 / $393.00 / $393.00
| Professional | TC | $239.00 | $393.00 | $393.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.53 / $164.83 / $400.00
| Professional | | $147.53 | $164.83 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.56 / $18.50 / $32.29
| Professional | 26 | $13.56 | $18.50 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $130.38 / $146.33 / $284.54
| Professional | TC | $130.38 | $146.33 | $284.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.29 / $209.18 / $457.60
| Professional | | $134.29 | $209.18 | $457.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.40 / $22.18 / $38.52
| Professional | 26 | $10.40 | $22.18 | $38.52 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $123.89 / $187.58 / $419.08
| Professional | TC | $123.89 | $187.58 | $419.08 |