- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $32.36 / $97.72
| Professional | | $17.38 | $32.36 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $16.98 / $33.88
| Professional | 26 | $7.08 | $16.98 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $28.84 / $83.18
| Professional | TC | $15.14 | $28.84 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | 26 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $138.04
| Professional | | $39.81 | $39.81 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.23 / $10.23 / $33.88
| Professional | 26 | $10.23 | $10.23 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.18 / $28.18 / $33.11
| Professional | TC | $28.18 | $28.18 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $42.66 / $100.00
| Professional | | $34.67 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $11.75 / $25.12
| Professional | 26 | $10.00 | $11.75 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.99 / $30.20 / $75.86
| Professional | TC | $23.99 | $30.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $138.04
| Professional | | $29.51 | $29.51 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $8.51 / $33.88
| Professional | 26 | $8.51 | $8.51 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Professional | TC | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $39.81 / $112.20
| Professional | | $31.62 | $39.81 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $10.72 / $27.54
| Professional | 26 | $8.32 | $10.72 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $28.18 / $85.11
| Professional | TC | $21.88 | $28.18 | $85.11 |