- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $17.05 / $27.07 / $121.51
| Facility | 26 | $17.05 | $27.07 | $121.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.71 / $68.86 / $275.43
| Professional | | $39.71 | $68.86 | $275.43 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.52 / $16.04 / $55.00
| Professional | 26 | $9.52 | $16.04 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.29 / $45.65 / $72.00
| Professional | TC | $26.29 | $45.65 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.73 / $69.80 / $91.68
| Professional | | $44.73 | $69.80 | $91.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.20 / $17.30 / $22.01
| Professional | 26 | $11.20 | $17.30 | $22.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.82 / $51.62 / $70.68
| Professional | TC | $32.82 | $51.62 | $70.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.09 / $29.46 / $39.23
| Professional | | $23.09 | $29.46 | $39.23 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $481.30 / $481.30 / $481.30
| Facility | 26 | $481.30 | $481.30 | $481.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.20 / $60.19 / $129.54
| Professional | | $44.20 | $60.19 | $129.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.48 / $15.69 / $29.68
| Professional | 26 | $11.48 | $15.69 | $29.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.67 / $44.49 / $99.85
| Professional | TC | $32.67 | $44.49 | $99.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.43 / $60.86 / $96.01
| Professional | | $48.43 | $60.86 | $96.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.73 / $14.44 / $21.95
| Professional | 26 | $10.73 | $14.44 | $21.95 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.44 / $46.94 / $75.59
| Professional | TC | $37.44 | $46.94 | $75.59 |