- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $7.90 / $10.26 / $58.48
| Facility | 26 | $7.90 | $10.26 | $58.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $17.35 / $21.21
| Professional | | $12.00 | $17.35 | $21.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.78 / $9.27 / $9.89
| Professional | 26 | $6.78 | $9.27 | $9.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $5.22 / $7.93 / $10.47
| Professional | TC | $5.22 | $7.93 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.15 / $17.50 / $24.03
| Professional | | $10.15 | $17.50 | $24.03 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.11 / $9.11 / $14.98
| Facility | 26 | $9.11 | $9.11 | $14.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.80 / $19.25 / $31.62
| Professional | | $15.80 | $19.25 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.53 / $9.89 / $15.56
| Professional | 26 | $8.53 | $9.89 | $15.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.28 / $8.76 / $15.77
| Professional | TC | $7.28 | $8.76 | $15.77 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $23.47 / $100.00 / $100.00
| Facility | 26 | $23.47 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.39 / $24.55 / $206.87
| Professional | | $17.39 | $24.55 | $206.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.43 / $11.01 / $105.66
| Professional | 26 | $9.43 | $11.01 | $105.66 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.46 / $11.03 / $129.58
| Professional | TC | $7.46 | $11.03 | $129.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $20.46 / $33.31
| Professional | | $16.57 | $20.46 | $33.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.25 / $10.33 / $16.25
| Professional | 26 | $9.25 | $10.33 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $7.36 / $9.26 / $16.73
| Professional | TC | $7.36 | $9.26 | $16.73 |