- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $67.61 / $177.83
| Facility | 26 | $37.15 | $67.61 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $128.82 / $257.04
| Professional | | $56.23 | $128.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $41.69 / $102.33
| Professional | 26 | $32.36 | $41.69 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $85.11 / $177.83
| Professional | TC | $15.85 | $85.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $112.20 / $263.03
| Professional | | $69.18 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $53.70 / $100.00
| Professional | 26 | $37.15 | $53.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $61.66 / $181.97
| Professional | TC | $21.38 | $61.66 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $54.95 / $162.18
| Facility | 26 | $9.77 | $54.95 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $162.18 / $380.19
| Professional | | $74.13 | $162.18 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $60.26 / $117.49
| Professional | 26 | $37.15 | $60.26 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $107.15 / $269.15
| Professional | TC | $16.98 | $107.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $125.89 / $257.04
| Professional | | $66.07 | $125.89 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.88 / $50.12 / $87.10
| Professional | 26 | $33.88 | $50.12 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $83.18 / $173.78
| Professional | TC | $16.98 | $83.18 | $173.78 |