- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.39 / $34.67 / $95.50
| Facility | 26 | $22.39 | $34.67 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $162.18 / $331.13
| Professional | | $114.82 | $162.18 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.89 / $26.30 / $77.62
| Professional | 26 | $20.89 | $26.30 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.20 / $114.82 / $245.47
| Professional | TC | $91.20 | $114.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Facility | 26 | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $288.40
| Professional | | $107.15 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $26.30 / $46.77
| Professional | 26 | $19.05 | $26.30 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.10 / $134.90 / $251.19
| Professional | TC | $87.10 | $134.90 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.62 / $30.20 / $72.44
| Facility | 26 | $5.62 | $30.20 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $363.08
| Professional | | $120.23 | $186.21 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.38 / $30.90 / $64.57
| Professional | 26 | $21.38 | $30.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $97.72 / $158.49 / $302.00
| Professional | TC | $97.72 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $162.18 / $288.40
| Professional | | $112.20 | $162.18 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.50 / $26.92 / $51.29
| Professional | 26 | $19.50 | $26.92 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $91.20 / $134.90 / $239.88
| Professional | TC | $91.20 | $134.90 | $239.88 |