- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.22 / $19.95 / $98.00
| Facility | 26 | $11.22 | $19.95 | $98.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.36 / $48.02 / $325.00
| Professional | | $25.36 | $48.02 | $325.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.65 / $11.22 / $21.24
| Professional | 26 | $8.65 | $11.22 | $21.24 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.15 / $56.50 / $227.00
| Professional | TC | $14.15 | $56.50 | $227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.70 / $17.70 / $38.24
| Professional | | $17.70 | $17.70 | $38.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.90 / $8.65 / $16.30
| Professional | 26 | $6.90 | $8.65 | $16.30 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.27 / $11.27 / $23.39
| Professional | TC | $11.27 | $11.27 | $23.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.00 / $127.00 / $127.00
| Professional | | $127.00 | $127.00 | $127.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.39 / $37.72 / $150.94
| Professional | | $19.39 | $37.72 | $150.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.02 / $14.72 / $20.18
| Professional | 26 | $8.02 | $14.72 | $20.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.42 / $22.08 / $134.46
| Professional | TC | $11.42 | $22.08 | $134.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.88 / $29.18 / $139.69
| Professional | | $20.88 | $29.18 | $139.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.10 / $11.12 / $19.39
| Professional | 26 | $8.10 | $11.12 | $19.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.31 / $16.05 / $118.27
| Professional | TC | $11.31 | $16.05 | $118.27 |