- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $8.52 / $18.73
| Facility | 26 | $7.78 | $8.52 | $18.73 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $18.01 / $35.65 / $291.47
| Facility | TC | $18.01 | $35.65 | $291.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.80 / $31.40 / $49.96
| Professional | | $25.80 | $31.40 | $49.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.78 / $8.83 / $18.73
| Professional | 26 | $7.78 | $8.83 | $18.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.02 / $21.07 / $43.32
| Professional | TC | $18.02 | $21.07 | $43.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.62 / $8.27 / $20.70
| Professional | 26 | $6.62 | $8.27 | $20.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.00 / $44.00 / $44.00
| Professional | | $44.00 | $44.00 | $44.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.73 / $39.72 / $55.38
| Professional | | $24.73 | $39.72 | $55.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.70 / $13.87 / $18.62
| Professional | 26 | $7.70 | $13.87 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.23 / $26.71 / $36.19
| Professional | TC | $17.23 | $26.71 | $36.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.54 / $32.34 / $32.34
| Professional | | $7.54 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $33.72 / $57.82
| Professional | | $21.44 | $33.72 | $57.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.43 / $10.71 / $20.23
| Professional | 26 | $7.43 | $10.71 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.65 / $22.84 / $40.57
| Professional | TC | $14.65 | $22.84 | $40.57 |