- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.14 / $15.14 / $25.70
| Facility | 26 | $15.14 | $15.14 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $34.67 / $61.66
| Professional | | $16.98 | $34.67 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.13 / $16.60 / $40.74
| Professional | 26 | $8.13 | $16.60 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.96 / $25.70 / $74.13
| Professional | TC | $10.96 | $25.70 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $109.65
| Professional | | $75.86 | $100.00 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.30 / $34.67 / $38.90
| Professional | 26 | $26.30 | $34.67 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.98 / $64.57 / $72.44
| Professional | TC | $48.98 | $64.57 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $66.07 / $100.00
| Professional | | $23.44 | $66.07 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $20.89 / $34.67
| Professional | 26 | $9.55 | $20.89 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.88 / $42.66 / $63.10
| Professional | TC | $12.88 | $42.66 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $42.66 / $741.31
| Professional | | $19.95 | $42.66 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.55 / $19.50 / $95.50
| Professional | 26 | $9.55 | $19.50 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $33.11 / $724.44
| Professional | TC | $11.75 | $33.11 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $41.69 / $104.71
| Professional | | $20.42 | $41.69 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.32 / $16.22 / $38.02
| Professional | 26 | $8.32 | $16.22 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.75 / $26.30 / $64.57
| Professional | TC | $11.75 | $26.30 | $64.57 |