- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.06 / $11.24 / $22.09
| Facility | 26 | $11.06 | $11.24 | $22.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.13 / $31.59 / $37.07
| Professional | | $30.13 | $31.59 | $37.07 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.31 / $9.66 / $11.53
| Professional | 26 | $9.31 | $9.66 | $11.53 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.82 / $21.93 / $28.17
| Professional | TC | $20.82 | $21.93 | $28.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.27 / $51.27 / $51.27
| Professional | | $51.27 | $51.27 | $51.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.86 / $41.38 / $56.86
| Professional | | $21.86 | $41.38 | $56.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.10 / $14.05 / $18.71
| Professional | 26 | $8.10 | $14.05 | $18.71 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.26 / $29.29 / $43.83
| Professional | TC | $16.26 | $29.29 | $43.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.61 / $22.61 / $100.00
| Facility | 26 | $22.61 | $22.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.06 / $39.11 / $206.60
| Professional | | $31.06 | $39.11 | $206.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.07 / $12.40 / $78.44
| Professional | 26 | $9.07 | $12.40 | $78.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.64 / $27.20 / $193.00
| Professional | TC | $20.64 | $27.20 | $193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.31 / $34.28 / $53.99
| Professional | | $30.31 | $34.28 | $53.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.07 / $10.64 / $17.64
| Professional | 26 | $9.07 | $10.64 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.42 / $22.09 / $36.19
| Professional | TC | $20.42 | $22.09 | $36.19 |