- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.28 / $38.28 / $38.28
| Facility | 26 | $38.28 | $38.28 | $38.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.62 / $58.14 / $268.00
| Professional | | $44.62 | $58.14 | $268.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.57 / $28.41 / $61.94
| Professional | 26 | $6.57 | $28.41 | $61.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.82 / $26.22 / $132.00
| Professional | TC | $18.82 | $26.22 | $132.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.28 / $39.28 / $39.28
| Professional | | $39.28 | $39.28 | $39.28 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.29 / $25.29 / $25.29
| Professional | 26 | $25.29 | $25.29 | $25.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.99 / $13.99 / $13.99
| Professional | TC | $13.99 | $13.99 | $13.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.71 / $52.59 / $67.18
| Professional | | $27.71 | $52.59 | $67.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.36 / $46.36 / $46.36
| Facility | 26 | $46.36 | $46.36 | $46.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.95 / $70.65 / $83.80
| Professional | | $48.95 | $70.65 | $83.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $28.95 / $40.42 / $46.97
| Professional | 26 | $28.95 | $40.42 | $46.97 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.98 / $30.46 / $36.92
| Professional | TC | $19.98 | $30.46 | $36.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.94 / $61.53 / $93.00
| Professional | | $55.94 | $61.53 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.68 / $33.75 / $50.74
| Professional | 26 | $30.68 | $33.75 | $50.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.80 / $27.78 / $42.94
| Professional | TC | $23.80 | $27.78 | $42.94 |