- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.44 / $13.31 / $23.80
| Facility | 26 | $10.44 | $13.31 | $23.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.67 / $40.35 / $48.94
| Professional | | $37.67 | $40.35 | $48.94 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.98 / $10.35 / $13.31
| Professional | 26 | $9.98 | $10.35 | $13.31 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.69 / $30.00 / $37.42
| Professional | TC | $27.69 | $30.00 | $37.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.94 / $65.94 / $65.94
| Professional | | $65.94 | $65.94 | $65.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.42 / $49.31 / $73.34
| Professional | | $27.42 | $49.31 | $73.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.92 / $15.04 / $20.00
| Professional | 26 | $8.92 | $15.04 | $20.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.86 / $38.22 / $59.94
| Professional | TC | $21.86 | $38.22 | $59.94 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.59 / $24.59 / $100.00
| Facility | 26 | $24.59 | $24.59 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $46.77 / $267.27
| Professional | | $37.04 | $46.77 | $267.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.19 / $13.69 / $85.85
| Professional | 26 | $10.19 | $13.69 | $85.85 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.85 / $33.07 / $244.00
| Professional | TC | $26.85 | $33.07 | $244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $42.85 / $68.54
| Professional | | $37.04 | $42.85 | $68.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.19 / $12.39 / $18.87
| Professional | 26 | $10.19 | $12.39 | $18.87 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.71 / $30.44 / $48.87
| Professional | TC | $26.71 | $30.44 | $48.87 |