- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $46.77 / $138.04
| Professional | | $26.92 | $46.77 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.96 / $17.78 / $43.65
| Professional | 26 | $10.96 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $40.74 / $100.00
| Professional | TC | $18.20 | $40.74 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | 26 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $63.10 / $181.97
| Professional | | $53.70 | $63.10 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.38 / $17.38 / $53.70
| Professional | 26 | $17.38 | $17.38 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.15 / $37.15 / $43.65
| Professional | TC | $37.15 | $37.15 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $128.82
| Professional | | $50.12 | $58.88 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.60 / $19.05 / $39.81
| Professional | 26 | $16.60 | $19.05 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $38.02 / $91.20
| Professional | TC | $31.62 | $38.02 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $181.97
| Professional | | $40.74 | $40.74 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $13.49 / $53.70
| Professional | 26 | $13.49 | $13.49 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.54 / $27.54 / $27.54
| Professional | TC | $27.54 | $27.54 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $56.23 / $144.54
| Professional | | $41.69 | $56.23 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $17.78 / $43.65
| Professional | 26 | $13.49 | $17.78 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $35.48 / $102.33
| Professional | TC | $26.30 | $35.48 | $102.33 |