- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $11.22 / $20.89
| Facility | 26 | $8.32 | $11.22 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $66.07 / $186.21
| Professional | | $51.29 | $66.07 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.94 / $10.00 / $33.11
| Professional | 26 | $7.94 | $10.00 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $8.13 / $39.81 / $39.81
| Professional | 52 | $8.13 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $42.66 / $52.48 / $100.00
| Professional | TC | $42.66 | $52.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $63.10 / $112.20
| Professional | | $45.71 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $9.55 / $17.38
| Professional | 26 | $7.59 | $9.55 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $39.81 / $54.95 / $97.72
| Professional | TC | $39.81 | $54.95 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.14 / $11.48 / $19.50
| Facility | 26 | $2.14 | $11.48 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $75.86 / $154.88
| Professional | | $54.95 | $75.86 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.91 / $12.02 / $23.99
| Professional | 26 | $8.91 | $12.02 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $45.71 / $64.57 / $131.83
| Professional | TC | $45.71 | $64.57 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $63.10 / $112.20
| Professional | | $45.71 | $63.10 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.59 / $10.23 / $17.78
| Professional | 26 | $7.59 | $10.23 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.90 / $53.70 / $95.50
| Professional | TC | $38.90 | $53.70 | $95.50 |