- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.27 / $12.42 / $22.20
| Facility | 26 | $11.27 | $12.42 | $22.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.21 / $19.26 / $22.57
| Professional | | $17.21 | $19.26 | $22.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.14 / $9.68 / $11.57
| Professional | 26 | $9.14 | $9.68 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.82 / $8.90 / $11.63
| Professional | TC | $7.82 | $8.90 | $11.63 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.42 / $10.67 / $10.67
| Professional | 26 | $10.42 | $10.67 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $38.90
| Professional | | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.13 / $27.30 / $50.00
| Professional | | $15.13 | $27.30 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.66 / $14.54 / $19.35
| Professional | 26 | $8.66 | $14.54 | $19.35 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.41 / $13.19 / $33.00
| Professional | TC | $7.41 | $13.19 | $33.00 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.47 / $23.47 / $100.00
| Facility | 26 | $23.47 | $23.47 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.48 / $28.67 / $206.87
| Professional | | $19.48 | $28.67 | $206.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.82 / $12.83 / $105.66
| Professional | 26 | $9.82 | $12.83 | $105.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.56 / $16.23 / $129.58
| Professional | TC | $8.56 | $16.23 | $129.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.19 / $22.80 / $36.69
| Professional | | $19.19 | $22.80 | $36.69 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.82 / $11.51 / $18.41
| Professional | 26 | $9.82 | $11.51 | $18.41 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $8.40 / $11.78 / $17.44
| Professional | TC | $8.40 | $11.78 | $17.44 |