- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $2.80 / $2.80 / $4.91
| Facility | 26 | $2.80 | $2.80 | $4.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.58 / $17.62 / $27.19
| Professional | | $13.58 | $17.62 | $27.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.54 / $3.71 / $5.61
| Professional | 26 | $2.54 | $3.71 | $5.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $10.72 / $14.07 / $21.65
| Professional | TC | $10.72 | $14.07 | $21.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $16.10 / $22.11
| Professional | | $3.50 | $16.10 | $22.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.19 / $26.18 / $36.77
| Professional | | $15.19 | $26.18 | $36.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $2.88 / $6.10 / $8.99
| Professional | 26 | $2.88 | $6.10 | $8.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $12.34 / $20.17 / $27.92
| Professional | TC | $12.34 | $20.17 | $27.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $5.94 / $100.00 / $100.00
| Facility | 26 | $5.94 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $23.99 / $161.00
| Professional | | $17.05 | $23.99 | $161.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.89 / $5.79 / $54.00
| Professional | 26 | $3.89 | $5.79 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.80 / $19.78 / $129.00
| Professional | TC | $14.80 | $19.78 | $129.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.19 / $23.88 / $34.79
| Professional | | $18.19 | $23.88 | $34.79 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $3.75 / $5.30 / $7.84
| Professional | 26 | $3.75 | $5.30 | $7.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.44 / $18.95 / $29.78
| Professional | TC | $14.44 | $18.95 | $29.78 |