- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.48 / $9.48 / $15.04
| Facility | 26 | $9.48 | $9.48 | $15.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.67 / $60.14 / $272.00
| Professional | | $52.67 | $60.14 | $272.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $9.48 / $38.00
| Professional | 26 | $7.95 | $9.48 | $38.00 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $26.10 / $29.24 / $41.38
| Professional | 52 | $26.10 | $29.24 | $41.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $43.71 / $49.01 / $71.48
| Professional | TC | $43.71 | $49.01 | $71.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.50 / $73.34 / $103.78
| Professional | | $59.50 | $73.34 | $103.78 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.43 / $11.89 / $17.48
| Professional | 26 | $9.43 | $11.89 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $49.79 / $60.97 / $87.39
| Professional | TC | $49.79 | $60.97 | $87.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.63 / $29.46 / $39.23
| Professional | | $22.63 | $29.46 | $39.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.94 / $83.70 / $115.54
| Professional | | $64.94 | $83.70 | $115.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.94 / $12.94 / $20.93
| Professional | 26 | $9.94 | $12.94 | $20.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $54.22 / $69.66 / $94.61
| Professional | TC | $54.22 | $69.66 | $94.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.29 / $63.60 / $94.36
| Professional | | $49.29 | $63.60 | $94.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.79 / $9.88 / $15.13
| Professional | 26 | $7.79 | $9.88 | $15.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.23 / $51.29 / $78.93
| Professional | TC | $41.23 | $51.29 | $78.93 |