- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.63 / $95.00 / $560.16
| Facility | | $45.63 | $95.00 | $560.16 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.71 / $7.71 / $7.87
| Facility | 26 | $7.71 | $7.71 | $7.87 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $20.65 / $430.64 / $430.64
| Facility | TC | $20.65 | $430.64 | $430.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.96 / $25.57 / $34.92
| Professional | | $21.96 | $25.57 | $34.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.43 / $6.82 / $9.15
| Professional | 26 | $6.43 | $6.82 | $9.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.53 / $18.82 / $25.77
| Professional | TC | $15.53 | $18.82 | $25.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $124.00 / $124.00
| Professional | | $75.00 | $124.00 | $124.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $20.00 / $34.00 / $34.00
| Professional | 26 | $20.00 | $34.00 | $34.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.00 / $90.00 / $90.00
| Professional | TC | $55.00 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $39.20 / $77.73
| Professional | | $26.92 | $39.20 | $77.73 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.16 / $12.32 / $21.29
| Professional | 26 | $8.16 | $12.32 | $21.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.76 / $27.39 / $53.28
| Professional | TC | $18.76 | $27.39 | $53.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.09 / $55.72 / $86.61
| Professional | | $29.09 | $55.72 | $86.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.81 / $15.21 / $25.29
| Professional | 26 | $7.81 | $15.21 | $25.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.73 / $35.28 / $60.63
| Professional | TC | $20.73 | $35.28 | $60.63 |