- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $47.86 / $48.98
| Facility | 26 | $47.86 | $47.86 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $100.00 / $138.04
| Professional | | $85.11 | $100.00 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $53.70 / $74.13
| Professional | TC | $43.65 | $53.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $229.09
| Professional | | $154.88 | $204.17 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $77.62 / $102.33 / $112.20
| Professional | TC | $77.62 | $102.33 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $173.78 / $269.15
| Professional | | $79.43 | $173.78 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.65 / $87.10 / $134.90
| Professional | TC | $43.65 | $87.10 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $645.65
| Professional | | $100.00 | $181.97 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.29 / $93.33 / $354.81
| Professional | TC | $51.29 | $93.33 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $245.47
| Professional | | $100.00 | $181.97 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $51.29 / $91.20 / $123.03
| Professional | TC | $51.29 | $91.20 | $123.03 |