- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.60 / $42.00 / $56.57
| Facility | 26 | $29.60 | $42.00 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.65 / $126.61 / $287.06
| Professional | | $101.65 | $126.61 | $287.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.74 / $32.61 / $56.57
| Professional | 26 | $23.74 | $32.61 | $56.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $69.04 / $101.94 / $230.50
| Professional | TC | $69.04 | $101.94 | $230.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.22 / $246.22 / $246.22
| Professional | | $246.22 | $246.22 | $246.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.72 / $235.11 / $351.49
| Professional | | $144.72 | $235.11 | $351.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.43 / $40.03 / $56.39
| Professional | 26 | $25.43 | $40.03 | $56.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $128.69 / $209.11 / $323.38
| Professional | TC | $128.69 | $209.11 | $323.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.93 / $82.93 / $160.47
| Facility | 26 | $82.93 | $82.93 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.65 / $250.78 / $1,341.64
| Professional | | $165.65 | $250.78 | $1,341.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.07 / $40.54 / $375.24
| Professional | 26 | $27.07 | $40.54 | $375.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.58 / $215.57 / $1,090.58
| Professional | TC | $138.58 | $215.57 | $1,090.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.65 / $211.21 / $322.80
| Professional | | $165.65 | $211.21 | $322.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.07 / $35.29 / $52.89
| Professional | 26 | $27.07 | $35.29 | $52.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $138.58 / $185.02 / $269.91
| Professional | TC | $138.58 | $185.02 | $269.91 |