- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.25 / $12.16 / $12.16
| Facility | 26 | $8.25 | $12.16 | $12.16 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $29.06 / $360.89
| Facility | TC | $20.42 | $29.06 | $360.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.61 / $29.29 / $43.27
| Professional | | $24.61 | $29.29 | $43.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.42 / $8.96 / $12.76
| Professional | 26 | $7.42 | $8.96 | $12.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.19 / $20.42 / $30.51
| Professional | TC | $17.19 | $20.42 | $30.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.38 / $24.38 / $24.88
| Professional | | $24.38 | $24.38 | $24.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $6.62 / $8.32
| Professional | 26 | $6.61 | $6.62 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.98 / $30.11 / $35.53
| Professional | | $21.98 | $30.11 | $35.53 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.37 / $8.73 / $10.30
| Professional | 26 | $6.37 | $8.73 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.61 / $21.38 / $25.23
| Professional | TC | $15.61 | $21.38 | $25.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.94 / $34.10 / $72.81
| Professional | | $22.94 | $34.10 | $72.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.28 / $11.92 / $22.16
| Professional | 26 | $7.28 | $11.92 | $22.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.23 / $22.84 / $56.39
| Professional | TC | $17.23 | $22.84 | $56.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $29.44 / $40.11
| Professional | | $22.75 | $29.44 | $40.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.31 / $9.32 / $13.34
| Professional | 26 | $7.31 | $9.32 | $13.34 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.02 / $20.81 / $26.85
| Professional | TC | $15.02 | $20.81 | $26.85 |