- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.88 / $13.39 / $25.35
| Facility | 26 | $9.88 | $13.39 | $25.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.01 / $65.34 / $225.68
| Professional | | $23.01 | $65.34 | $225.68 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $10.31 / $49.00
| Professional | 26 | $8.83 | $10.31 | $49.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.96 / $31.84 / $93.28
| Professional | TC | $13.96 | $31.84 | $93.28 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.37 / $10.37 / $10.37
| Facility | 26 | $10.37 | $10.37 | $10.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.11 / $36.36 / $93.37
| Professional | | $23.11 | $36.36 | $93.37 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.01 / $12.33 / $19.45
| Professional | 26 | $9.01 | $12.33 | $19.45 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.08 / $23.27 / $83.57
| Professional | TC | $15.08 | $23.27 | $83.57 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.80 / $10.80 / $10.80
| Facility | 26 | $10.80 | $10.80 | $10.80 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $5.59 / $5.59 / $5.59
| Facility | 53 | $5.59 | $5.59 | $5.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.74 / $48.37 / $146.83
| Professional | | $22.74 | $48.37 | $146.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.57 / $13.53 / $21.89
| Professional | 26 | $8.57 | $13.53 | $21.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.70 / $28.39 / $134.46
| Professional | TC | $13.70 | $28.39 | $134.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $38.06 / $124.19
| Professional | | $21.51 | $38.06 | $124.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $11.67 / $20.64
| Professional | 26 | $8.71 | $11.67 | $20.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.01 / $20.84 / $93.41
| Professional | TC | $12.01 | $20.84 | $93.41 |