- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.73 / $34.20 / $60.54
| Facility | 26 | $26.73 | $34.20 | $60.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.59 / $120.48 / $459.00
| Professional | | $98.59 | $120.48 | $459.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.26 / $29.83 / $114.00
| Professional | 26 | $23.26 | $29.83 | $114.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $72.65 / $86.57 / $137.19
| Professional | TC | $72.65 | $86.57 | $137.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.88 / $26.88 / $26.88
| Facility | 26 | $26.88 | $26.88 | $26.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.04 / $139.47 / $219.32
| Professional | | $96.04 | $139.47 | $219.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.90 / $36.11 / $59.97
| Professional | 26 | $24.90 | $36.11 | $59.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $73.37 / $107.64 / $173.15
| Professional | TC | $73.37 | $107.64 | $173.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.20 / $28.20 / $28.20
| Facility | 26 | $28.20 | $28.20 | $28.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.08 / $147.31 / $253.48
| Professional | | $103.08 | $147.31 | $253.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.88 / $37.13 / $63.00
| Professional | 26 | $25.88 | $37.13 | $63.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $78.33 / $110.07 / $194.54
| Professional | TC | $78.33 | $110.07 | $194.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.65 / $131.97 / $225.99
| Professional | | $97.65 | $131.97 | $225.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.22 / $34.71 / $54.72
| Professional | 26 | $25.22 | $34.71 | $54.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $70.93 / $100.48 / $167.00
| Professional | TC | $70.93 | $100.48 | $167.00 |