- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.56 / $31.11 / $44.68
| Facility | 26 | $27.56 | $31.11 | $44.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.45 / $103.79 / $149.54
| Professional | | $79.45 | $103.79 | $149.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.13 / $31.11 / $49.90
| Professional | 26 | $22.13 | $31.11 | $49.90 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $56.74 / $73.91 / $112.50
| Professional | TC | $56.74 | $73.91 | $112.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.27 / $68.27 / $68.27
| Professional | | $68.27 | $68.27 | $68.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $24.44 / $28.70 / $28.70
| Professional | 26 | $24.44 | $28.70 | $28.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.54 / $127.08 / $166.83
| Professional | | $113.54 | $127.08 | $166.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.83 / $39.49 / $48.50
| Professional | 26 | $30.83 | $39.49 | $48.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.72 / $90.24 / $142.29
| Professional | TC | $82.72 | $90.24 | $142.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $23.84 / $23.84 / $25.41
| Professional | 26 | $23.84 | $23.84 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.80 / $103.70 / $172.26
| Professional | | $57.80 | $103.70 | $172.26 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $16.25 / $28.25 / $49.72
| Professional | 26 | $16.25 | $28.25 | $49.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.55 / $68.93 / $124.95
| Professional | TC | $41.55 | $68.93 | $124.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.37 / $96.98 / $152.11
| Professional | | $70.37 | $96.98 | $152.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.59 / $28.65 / $48.07
| Professional | 26 | $21.59 | $28.65 | $48.07 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $48.07 / $68.87 / $103.64
| Professional | TC | $48.07 | $68.87 | $103.64 |