- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.46 / $9.47 / $16.19
| Professional | 26 | $7.46 | $9.47 | $16.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.57 / $23.12 / $39.11
| Professional | TC | $18.57 | $23.12 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.06 / $10.06 / $10.86
| Professional | 26 | $10.06 | $10.06 | $10.86 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.63 / $11.93 / $21.83
| Professional | 26 | $8.63 | $11.93 | $21.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.64 / $27.79 / $51.30
| Professional | TC | $19.64 | $27.79 | $51.30 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.59 / $77.59 / $86.55
| Professional | 26 | $77.59 | $77.59 | $86.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $227.48 / $300.00 / $300.00
| Professional | TC | $227.48 | $300.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $13.46 / $17.07 / $33.64
| Professional | 26 | $13.46 | $17.07 | $33.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $33.64 / $45.29 / $62.44
| Professional | TC | $33.64 | $45.29 | $62.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.68 / $11.65 / $21.22
| Professional | 26 | $8.68 | $11.65 | $21.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.64 / $27.39 / $49.58
| Professional | TC | $19.64 | $27.39 | $49.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.22 / $10.97 / $18.14
| Professional | 26 | $9.22 | $10.97 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.91 / $26.06 / $43.24
| Professional | TC | $21.91 | $26.06 | $43.24 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.83 / $10.15 / $14.05
| Professional | 26 | $8.83 | $10.15 | $14.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.09 / $24.45 / $35.13
| Professional | TC | $22.09 | $24.45 | $35.13 |