- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.02 / $38.90 / $63.10
| Facility | 26 | $38.02 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $79.43 / $173.78
| Professional | | $56.23 | $79.43 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $44.67 / $114.82
| Professional | 26 | $37.15 | $44.67 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.98 / $37.15 / $63.10
| Professional | TC | $16.98 | $37.15 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $100.00 / $181.97
| Professional | | $67.61 | $100.00 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $151.36 / $234.42
| Professional | | $107.15 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $52.48 / $74.13 / $114.82
| Professional | 26 | $52.48 | $74.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $69.18 / $117.49
| Professional | TC | $52.48 | $69.18 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $83.18 / $83.18 / $177.83
| Facility | 26 | $83.18 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $120.23 / $562.34
| Professional | | $61.66 | $120.23 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.90 / $77.62 / $234.42
| Professional | 26 | $38.90 | $77.62 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $37.15 / $245.47
| Professional | TC | $20.42 | $37.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $120.23 / $165.96
| Professional | | $67.61 | $120.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $40.74 / $67.61 / $93.33
| Professional | 26 | $40.74 | $67.61 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $51.29 / $74.13
| Professional | TC | $23.99 | $51.29 | $74.13 |