- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.86 / $9.34 / $54.89
| Facility | 26 | $7.86 | $9.34 | $54.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.51 / $29.76 / $32.49
| Professional | | $20.51 | $29.76 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.55 / $9.09 / $9.88
| Professional | 26 | $6.55 | $9.09 | $9.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $13.96 / $20.66 / $22.61
| Professional | TC | $13.96 | $20.66 | $22.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.69 / $29.75 / $40.85
| Professional | | $10.69 | $29.75 | $40.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.47 / $8.47 / $13.93
| Facility | 26 | $8.47 | $8.47 | $13.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.83 / $27.46 / $43.83
| Professional | | $23.83 | $27.46 | $43.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.09 / $9.55 / $14.56
| Professional | 26 | $8.09 | $9.55 | $14.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $15.36 / $18.32 / $29.56
| Professional | TC | $15.36 | $18.32 | $29.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.61 / $100.00 / $100.00
| Facility | 26 | $22.61 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.04 / $35.36 / $206.60
| Professional | | $26.04 | $35.36 | $206.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.90 / $10.47 / $78.44
| Professional | 26 | $8.90 | $10.47 | $78.44 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.03 / $22.73 / $193.00
| Professional | TC | $17.03 | $22.73 | $193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.64 / $31.76 / $48.25
| Professional | | $25.64 | $31.76 | $48.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.86 / $9.93 / $15.86
| Professional | 26 | $8.86 | $9.93 | $15.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.25 / $20.62 / $33.00
| Professional | TC | $16.25 | $20.62 | $33.00 |