- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.41 / $9.41 / $9.41
| Facility | 26 | $9.41 | $9.41 | $9.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.92 / $31.82 / $155.00
| Professional | | $24.92 | $31.82 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.61 / $13.26 / $37.19
| Professional | 26 | $7.61 | $13.26 | $37.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.09 / $22.94 / $51.18
| Professional | TC | $19.09 | $22.94 | $51.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.99 / $36.11 / $61.97
| Professional | | $26.99 | $36.11 | $61.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.26 / $11.40 / $18.25
| Professional | 26 | $9.26 | $11.40 | $18.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.68 / $25.20 / $43.66
| Professional | TC | $17.68 | $25.20 | $43.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.02 / $28.89 / $38.52
| Professional | | $22.02 | $28.89 | $38.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $147.24 / $147.24 / $147.24
| Facility | 26 | $147.24 | $147.24 | $147.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.60 / $52.90 / $62.16
| Professional | | $46.60 | $52.90 | $62.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.89 / $16.07 / $18.07
| Professional | 26 | $12.89 | $16.07 | $18.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.71 / $37.45 / $43.31
| Professional | TC | $33.71 | $37.45 | $43.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $31.04 / $51.22
| Professional | | $26.92 | $31.04 | $51.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.17 / $9.38 / $15.48
| Professional | 26 | $8.17 | $9.38 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.37 / $21.66 / $35.74
| Professional | TC | $19.37 | $21.66 | $35.74 |