- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.61 / $52.49 / $96.60
| Facility | 26 | $35.61 | $52.49 | $96.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $164.35 / $313.76
| Professional | | $128.72 | $164.35 | $313.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.03 / $48.52 / $108.80
| Professional | 26 | $33.03 | $48.52 | $108.80 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $92.99 / $112.25 / $237.55
| Professional | TC | $92.99 | $112.25 | $237.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.44 / $90.03 / $304.25
| Professional | | $73.44 | $90.03 | $304.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.60 / $29.38 / $89.20
| Professional | 26 | $22.60 | $29.38 | $89.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.86 / $65.83 / $193.01
| Professional | TC | $54.86 | $65.83 | $193.01 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.30 / $101.53 / $101.53
| Facility | 26 | $88.30 | $101.53 | $101.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.13 / $137.29 / $304.00
| Professional | | $77.13 | $137.29 | $304.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.21 / $40.13 / $93.60
| Professional | 26 | $22.21 | $40.13 | $93.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.27 / $83.86 / $220.87
| Professional | TC | $50.27 | $83.86 | $220.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.13 / $156.34 / $290.45
| Professional | | $95.13 | $156.34 | $290.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.50 / $43.73 / $84.96
| Professional | 26 | $27.50 | $43.73 | $84.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $65.56 / $103.47 / $219.83
| Professional | TC | $65.56 | $103.47 | $219.83 |