- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $102.33 / $173.78
| Facility | 26 | $36.31 | $102.33 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $112.20 / $234.42
| Professional | | $81.28 | $112.20 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $60.26 / $457.09
| Professional | 26 | $33.11 | $60.26 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $72.44 / $199.53
| Professional | TC | $52.48 | $72.44 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $112.20 / $331.13
| Professional | | $60.26 | $112.20 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $43.65 / $120.23
| Professional | 26 | $22.39 | $43.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $69.18 / $208.93
| Professional | TC | $39.81 | $69.18 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $14.45 / $67.61 / $117.49
| Facility | 26 | $14.45 | $67.61 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $120.23 / $269.15
| Professional | | $58.88 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $43.65 / $102.33
| Professional | 26 | $20.89 | $43.65 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.15 / $72.44 / $169.82
| Professional | TC | $37.15 | $72.44 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $125.89 / $263.03
| Professional | | $72.44 | $125.89 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.92 / $45.71 / $97.72
| Professional | 26 | $26.92 | $45.71 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.77 / $77.62 / $165.96
| Professional | TC | $46.77 | $77.62 | $165.96 |