- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.12 / $20.86 / $26.60
| Facility | 26 | $12.12 | $20.86 | $26.60 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $24.82 / $44.86 / $56.67
| Facility | TC | $24.82 | $44.86 | $56.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.22 / $41.49 / $81.09
| Professional | | $34.22 | $41.49 | $81.09 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.32 / $13.71 / $26.60
| Professional | 26 | $11.32 | $13.71 | $26.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.85 / $27.56 / $54.49
| Professional | TC | $22.85 | $27.56 | $54.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.95 / $32.95 / $32.95
| Professional | | $32.95 | $32.95 | $32.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.85 / $23.49 / $30.03
| Professional | 26 | $9.85 | $23.49 | $30.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $60.00
| Professional | | $60.00 | $60.00 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $52.90 / $73.45
| Professional | | $32.61 | $52.90 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.20 / $20.62 / $27.79
| Professional | 26 | $11.20 | $20.62 | $27.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.54 / $33.39 / $45.29
| Professional | TC | $21.54 | $33.39 | $45.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.94 / $32.34 / $32.36
| Professional | | $10.94 | $32.34 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.98 / $44.40 / $76.68
| Professional | | $29.98 | $44.40 | $76.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.26 / $16.09 / $33.21
| Professional | 26 | $11.26 | $16.09 | $33.21 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.30 / $28.40 / $50.02
| Professional | TC | $18.30 | $28.40 | $50.02 |