- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.79 / $44.80 / $60.47
| Facility | 26 | $44.79 | $44.80 | $60.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.35 / $100.20 / $151.59
| Professional | | $83.35 | $100.20 | $151.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.96 / $31.46 / $47.03
| Professional | 26 | $25.96 | $31.46 | $47.03 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $57.39 / $68.75 / $104.55
| Professional | TC | $57.39 | $68.75 | $104.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.58 / $80.58 / $80.58
| Professional | | $80.58 | $80.58 | $80.58 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.33 / $40.29 / $40.29
| Professional | 26 | $24.33 | $40.29 | $40.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.80 / $106.58 / $125.76
| Professional | | $77.80 | $106.58 | $125.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.09 / $34.36 / $40.56
| Professional | 26 | $25.09 | $34.36 | $40.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $52.71 / $72.20 / $85.21
| Professional | TC | $52.71 | $72.20 | $85.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.52 / $114.70 / $193.76
| Professional | | $76.52 | $114.70 | $193.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.51 / $43.15 / $68.01
| Professional | 26 | $26.51 | $43.15 | $68.01 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $58.46 / $83.01 / $141.25
| Professional | TC | $58.46 | $83.01 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.61 / $100.72 / $144.96
| Professional | | $80.61 | $100.72 | $144.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.80 / $34.36 / $49.26
| Professional | 26 | $26.80 | $34.36 | $49.26 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $55.55 / $67.67 / $97.79
| Professional | TC | $55.55 | $67.67 | $97.79 |