- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $7.94 / $20.89
| Facility | 26 | $7.76 | $7.94 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- TC
- Low / Median / High Price
- $19.05 / $44.67 / $323.59
| Facility | TC | $19.05 | $44.67 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $34.67 / $57.54
| Professional | | $20.89 | $34.67 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.08 / $8.91 / $20.89
| Professional | 26 | $7.08 | $8.91 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.20 / $22.91 / $38.90
| Professional | TC | $18.20 | $22.91 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $29.51 / $48.98
| Professional | | $19.50 | $29.51 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.76 / $9.33 / $16.60
| Professional | 26 | $6.76 | $9.33 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.80 / $23.99 / $36.31
| Professional | TC | $13.80 | $23.99 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Professional | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $39.81 / $54.95
| Professional | | $22.39 | $39.81 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $12.88 / $18.62
| Professional | 26 | $6.61 | $12.88 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.22 / $26.92 / $36.31
| Professional | TC | $16.22 | $26.92 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $32.36 / $33.11
| Professional | | $18.20 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $32.36 / $57.54
| Professional | | $22.39 | $32.36 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.76 / $10.47 / $19.50
| Professional | 26 | $7.76 | $10.47 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.79 / $22.39 / $37.15
| Professional | TC | $14.79 | $22.39 | $37.15 |