- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.71 / $10.26 / $19.09
| Facility | 26 | $9.71 | $10.26 | $19.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.03 / $31.56 / $36.99
| Professional | | $28.03 | $31.56 | $36.99 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.63 / $8.34 / $9.94
| Professional | 26 | $7.63 | $8.34 | $9.94 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.39 / $23.22 / $31.11
| Professional | TC | $20.39 | $23.22 | $31.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.18 / $6.18 / $6.26
| Professional | 26 | $6.18 | $6.18 | $6.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.30 / $52.30 / $52.30
| Professional | | $52.30 | $52.30 | $52.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.80 / $40.82 / $57.38
| Professional | | $21.80 | $40.82 | $57.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.98 / $12.08 / $15.64
| Professional | 26 | $6.98 | $12.08 | $15.64 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.79 / $31.18 / $46.43
| Professional | TC | $17.79 | $31.18 | $46.43 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.60 / $19.60 / $100.00
| Facility | 26 | $19.60 | $19.60 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.40 / $38.25 / $208.83
| Professional | | $30.40 | $38.25 | $208.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $10.81 / $66.04
| Professional | 26 | $7.95 | $10.81 | $66.04 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.90 / $27.89 / $188.00
| Professional | TC | $21.90 | $27.89 | $188.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.38 / $33.44 / $50.50
| Professional | | $30.38 | $33.44 | $50.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.95 / $9.28 / $14.73
| Professional | 26 | $7.95 | $9.28 | $14.73 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.26 / $24.62 / $37.44
| Professional | TC | $21.26 | $24.62 | $37.44 |