- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $45.71 / $134.90
| Professional | | $25.70 | $45.71 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $16.98 / $32.36
| Professional | 26 | $7.94 | $16.98 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $32.36 / $102.33
| Professional | TC | $18.62 | $32.36 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | 26 | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $56.23 / $165.96
| Professional | | $47.86 | $56.23 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.49 / $15.85 / $44.67
| Professional | 26 | $13.49 | $15.85 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.67 / $34.67 / $40.74
| Professional | TC | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $51.29 / $120.23
| Professional | | $44.67 | $51.29 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.30 / $15.14 / $32.36
| Professional | 26 | $12.30 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $31.62 / $36.31 / $89.13
| Professional | TC | $31.62 | $36.31 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $165.96
| Professional | | $35.48 | $35.48 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $9.55 / $44.67
| Professional | 26 | $9.55 | $9.55 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Professional | TC | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $48.98 / $134.90
| Professional | | $38.90 | $48.98 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $14.13 / $36.31
| Professional | 26 | $11.22 | $14.13 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.12 / $34.67 / $100.00
| Professional | TC | $25.12 | $34.67 | $100.00 |