- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.56 / $38.43 / $72.06
| Facility | 26 | $30.56 | $38.43 | $72.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.90 / $89.33 / $127.20
| Professional | | $48.90 | $89.33 | $127.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.78 / $36.88 / $61.22
| Professional | 26 | $24.78 | $36.88 | $61.22 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $18.29 / $48.82 / $89.70
| Professional | TC | $18.29 | $48.82 | $89.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.34 / $35.34 / $35.34
| Professional | | $35.34 | $35.34 | $35.34 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.98 / $47.02 / $67.12
| Professional | 26 | $44.98 | $47.02 | $67.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.90 / $72.16 / $186.20
| Professional | | $61.90 | $72.16 | $186.20 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.85 / $55.67 / $65.98
| Professional | 26 | $37.85 | $55.67 | $65.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $11.14 / $13.78 / $154.91
| Professional | TC | $11.14 | $13.78 | $154.91 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $31.44 / $40.31 / $48.30
| Professional | 26 | $31.44 | $40.31 | $48.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.72 / $63.99 / $169.72
| Professional | | $32.72 | $63.99 | $169.72 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.44 / $40.07 / $60.15
| Professional | 26 | $22.44 | $40.07 | $60.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $6.09 / $17.67 / $109.79
| Professional | TC | $6.09 | $17.67 | $109.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.31 / $86.94 / $172.45
| Professional | | $64.31 | $86.94 | $172.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.09 / $32.11 / $51.39
| Professional | 26 | $24.09 | $32.11 | $51.39 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $36.99 / $51.61 / $107.46
| Professional | TC | $36.99 | $51.61 | $107.46 |