- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $14.45 / $38.90
| Facility | 26 | $7.94 | $14.45 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $38.02 / $112.20
| Professional | | $22.91 | $38.02 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $10.72 / $31.62
| Professional | 26 | $7.08 | $10.72 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $30.20 / $39.81 / $93.33
| Professional | 52 | $30.20 | $39.81 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.14 / $23.99 / $53.70
| Professional | TC | $15.14 | $23.99 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | 26 | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $39.81 / $72.44
| Professional | | $25.12 | $39.81 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $12.88 / $22.39
| Professional | 26 | $7.94 | $12.88 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $28.18 / $50.12
| Professional | TC | $18.20 | $28.18 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.19 / $11.75 / $28.18
| Facility | 26 | $2.19 | $11.75 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $44.67 / $83.18
| Professional | | $25.70 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $13.18 / $25.70
| Professional | 26 | $7.76 | $13.18 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.78 / $30.90 / $58.88
| Professional | TC | $17.78 | $30.90 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $36.31 / $66.07
| Professional | | $26.92 | $36.31 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.72 / $19.50
| Professional | 26 | $7.94 | $10.72 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.62 / $25.70 / $45.71
| Professional | TC | $18.62 | $25.70 | $45.71 |