- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $8.91 / $16.60
| Facility | 26 | $8.91 | $8.91 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $234.42
| Professional | | $32.36 | $45.71 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $9.77 / $26.92
| Professional | 26 | $8.32 | $9.77 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.91 / $33.88 / $208.93
| Professional | TC | $22.91 | $33.88 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $91.20 / $102.33
| Professional | | $69.18 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.22 / $21.88 / $23.99
| Professional | 26 | $16.22 | $21.88 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.48 / $69.18 / $77.62
| Professional | TC | $52.48 | $69.18 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $74.13 / $128.82
| Professional | | $34.67 | $74.13 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.51 / $13.80 / $23.99
| Professional | 26 | $8.51 | $13.80 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $57.54 / $112.20
| Professional | TC | $25.70 | $57.54 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $72.44 / $537.03
| Professional | | $36.31 | $72.44 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $19.05 / $97.72
| Professional | 26 | $10.00 | $19.05 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $58.88 / $489.78
| Professional | TC | $30.20 | $58.88 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $70.79 / $104.71
| Professional | | $39.81 | $70.79 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $16.98 / $25.12
| Professional | 26 | $7.94 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $30.20 / $56.23 / $85.11
| Professional | TC | $30.20 | $56.23 | $85.11 |