- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.33 / $41.27 / $56.98
| Facility | 26 | $34.33 | $41.27 | $56.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.59 / $69.43 / $142.50
| Professional | | $68.59 | $69.43 | $142.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $33.22 / $34.72 / $215.00
| Professional | 26 | $33.22 | $34.72 | $215.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.87 / $34.29 / $75.38
| Professional | TC | $29.87 | $34.29 | $75.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.47 / $78.75 / $110.63
| Professional | | $43.47 | $78.75 | $110.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $98.36 / $134.71
| Professional | | $70.34 | $98.36 | $134.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.94 / $57.36 / $84.49
| Professional | 26 | $40.94 | $57.36 | $84.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.55 / $39.47 / $61.00
| Professional | TC | $24.55 | $39.47 | $61.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.51 / $95.51 / $204.09
| Facility | 26 | $95.51 | $95.51 | $204.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.65 / $82.23 / $178.07
| Professional | | $62.65 | $82.23 | $178.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.54 / $47.11 / $271.97
| Professional | 26 | $36.54 | $47.11 | $271.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.94 / $33.29 / $290.20
| Professional | TC | $21.94 | $33.29 | $290.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.65 / $78.31 / $139.53
| Professional | | $62.65 | $78.31 | $139.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.54 / $46.24 / $72.65
| Professional | 26 | $36.54 | $46.24 | $72.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.94 / $32.56 / $61.46
| Professional | TC | $21.94 | $32.56 | $61.46 |