- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $9.86 / $9.86 / $19.55
| Facility | 26 | $9.86 | $9.86 | $19.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.97 / $31.66 / $45.01
| Professional | | $27.97 | $31.66 | $45.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.06 / $10.77 / $16.18
| Professional | 26 | $10.06 | $10.77 | $16.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.89 / $20.89 / $28.82
| Professional | TC | $17.89 | $20.89 | $28.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $29.75 / $40.85
| Professional | | $10.85 | $29.75 | $40.85 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.13 / $22.13 / $22.13
| Facility | 26 | $22.13 | $22.13 | $22.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.22 / $46.81 / $53.21
| Professional | | $31.22 | $46.81 | $53.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.19 / $18.05 / $22.92
| Professional | 26 | $11.19 | $18.05 | $22.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.03 / $26.55 / $31.40
| Professional | TC | $20.03 | $26.55 | $31.40 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $24.22 / $70.00 / $70.00
| Facility | 26 | $24.22 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $39.78 / $195.66
| Professional | | $32.21 | $39.78 | $195.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.56 / $17.32 / $69.84
| Professional | 26 | $12.56 | $17.32 | $69.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.93 / $26.96 / $129.61
| Professional | TC | $19.93 | $26.96 | $129.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $39.78 / $72.48
| Professional | | $32.21 | $39.78 | $72.48 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.28 / $15.88 / $27.62
| Professional | 26 | $12.28 | $15.88 | $27.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.87 / $24.62 / $43.64
| Professional | TC | $19.87 | $24.62 | $43.64 |