- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $18.20 / $18.20 / $18.20
| Facility | 26 | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $45.71 / $93.33
| Professional | | $32.36 | $45.71 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.00 / $15.49 / $34.67
| Professional | 26 | $10.00 | $15.49 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.38 / $34.67 / $69.18
| Professional | TC | $21.38 | $34.67 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.88 / $21.88 / $21.88
| Professional | 26 | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $25.70 / $25.70
| Professional | TC | $25.70 | $25.70 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $45.71 / $57.54
| Professional | | $31.62 | $45.71 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.77 / $13.80 / $17.78
| Professional | 26 | $9.77 | $13.80 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.88 / $31.62 / $39.81
| Professional | TC | $21.88 | $31.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.49 / $15.49 / $15.49
| Facility | 26 | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $100.00
| Professional | | $32.36 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.59 / $17.78 / $35.48
| Professional | 26 | $12.59 | $17.78 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.70 / $37.15 / $79.43
| Professional | TC | $25.70 | $37.15 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $44.67 / $63.10
| Professional | | $33.11 | $44.67 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.47 / $13.80 / $20.42
| Professional | 26 | $10.47 | $13.80 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $22.39 / $30.20 / $42.66
| Professional | TC | $22.39 | $30.20 | $42.66 |