- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $31.62 / $51.29
| Facility | 26 | $23.44 | $31.62 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $54.95 / $223.87
| Professional | | $38.02 | $54.95 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.44 / $30.20 / $75.86
| Professional | 26 | $23.44 | $30.20 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $33.11 / $309.03 / $323.59
| Professional | 52 | $33.11 | $309.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.85 / $22.91 / $66.07
| Professional | TC | $15.85 | $22.91 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | 26 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $60.26 / $125.89
| Professional | | $46.77 | $60.26 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.54 / $33.88 / $67.61
| Professional | 26 | $27.54 | $33.88 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $26.92 / $60.26
| Professional | TC | $21.38 | $26.92 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.61 / $35.48 / $91.20
| Facility | 26 | $6.61 | $35.48 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $63.10
| Professional | | $38.90 | $38.90 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $25.12 / $39.81
| Professional | 26 | $25.12 | $25.12 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.13 / $14.13 / $22.91
| Professional | TC | $14.13 | $14.13 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $61.66 / $107.15
| Professional | | $44.67 | $61.66 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.55 / $33.88 / $60.26
| Professional | 26 | $24.55 | $33.88 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.50 / $27.54 / $47.86
| Professional | TC | $19.50 | $27.54 | $47.86 |