- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $38.90 / $102.33
| Facility | 26 | $25.12 | $38.90 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $120.23 / $269.15
| Professional | | $85.11 | $120.23 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.91 / $32.36 / $83.18
| Professional | 26 | $22.91 | $32.36 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $60.26 / $79.43 / $162.18
| Professional | TC | $60.26 | $79.43 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Facility | 26 | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $125.89 / $239.88
| Professional | | $79.43 | $125.89 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.12 / $34.67 / $64.57
| Professional | 26 | $25.12 | $34.67 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $93.33 / $177.83
| Professional | TC | $61.66 | $93.33 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $6.92 / $37.15 / $91.20
| Facility | 26 | $6.92 | $37.15 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $275.42
| Professional | | $85.11 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $39.81 / $75.86
| Professional | 26 | $23.99 | $39.81 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $104.71 / $204.17
| Professional | TC | $61.66 | $104.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $114.82 / $213.80
| Professional | | $87.10 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.99 / $32.36 / $58.88
| Professional | 26 | $23.99 | $32.36 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $61.66 / $83.18 / $154.88
| Professional | TC | $61.66 | $83.18 | $154.88 |