- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.54 / $34.37 / $57.36
| Facility | 26 | $26.54 | $34.37 | $57.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.13 / $101.07 / $246.51
| Professional | | $51.13 | $101.07 | $246.51 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.20 / $29.52 / $81.39
| Professional | 26 | $24.20 | $29.52 | $81.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $26.01 / $57.68 / $98.75
| Professional | TC | $26.01 | $57.68 | $98.75 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.40 / $30.40 / $30.40
| Facility | 26 | $30.40 | $30.40 | $30.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.87 / $89.43 / $135.59
| Professional | | $58.87 | $89.43 | $135.59 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.86 / $36.86 / $54.15
| Professional | 26 | $26.86 | $36.86 | $54.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $32.35 / $48.34 / $90.36
| Professional | TC | $32.35 | $48.34 | $90.36 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Facility | 26 | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.25 / $94.72 / $173.60
| Professional | | $52.25 | $94.72 | $173.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.13 / $38.27 / $63.99
| Professional | 26 | $24.13 | $38.27 | $63.99 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.33 / $51.77 / $110.52
| Professional | TC | $27.33 | $51.77 | $110.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.04 / $83.83 / $145.44
| Professional | | $56.04 | $83.83 | $145.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $26.63 / $32.54 / $55.61
| Professional | 26 | $26.63 | $32.54 | $55.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $28.80 / $44.45 / $87.55
| Professional | TC | $28.80 | $44.45 | $87.55 |