- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.67 / $43.65 / $43.65
| Facility | 26 | $34.67 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $56.23 / $100.00
| Professional | | $36.31 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $43.65 / $229.09
| Professional | 26 | $25.12 | $43.65 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $19.05 / $37.15
| Professional | TC | $12.88 | $19.05 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $32.36 / $36.31
| Professional | 26 | $32.36 | $32.36 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $64.57 / $74.13
| Professional | | $58.88 | $64.57 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.48 / $40.74 / $50.12
| Professional | 26 | $35.48 | $40.74 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $23.99 / $27.54
| Professional | TC | $22.91 | $23.99 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | 26 | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $30.90 / $93.33
| Professional | | $25.70 | $30.90 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $15.85 / $20.89 / $63.10
| Professional | 26 | $15.85 | $20.89 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $9.12 / $10.23 / $33.11
| Professional | TC | $9.12 | $10.23 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $57.54 / $102.33
| Professional | | $30.20 | $57.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.42 / $37.15 / $64.57
| Professional | 26 | $20.42 | $37.15 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.72 / $19.50 / $34.67
| Professional | TC | $10.72 | $19.50 | $34.67 |