- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.60 / $51.97 / $57.16
| Facility | 26 | $34.60 | $51.97 | $57.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.40 / $96.64 / $127.14
| Professional | | $62.40 | $96.64 | $127.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $27.07 / $47.95 / $57.16
| Professional | 26 | $27.07 | $47.95 | $57.16 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $35.34 / $46.99 / $59.42
| Professional | TC | $35.34 | $46.99 | $59.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.90 / $76.90 / $76.90
| Professional | | $76.90 | $76.90 | $76.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.65 / $36.18 / $50.66
| Professional | 26 | $25.65 | $36.18 | $50.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.91 / $97.65 / $120.06
| Professional | | $75.91 | $97.65 | $120.06 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $38.10 / $49.91 / $59.17
| Professional | 26 | $38.10 | $49.91 | $59.17 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $37.81 / $47.74 / $62.05
| Professional | TC | $37.81 | $47.74 | $62.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $30.01 / $98.34 / $98.34
| Professional | 26 | $30.01 | $98.34 | $98.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.86 / $68.20 / $124.16
| Professional | | $43.86 | $68.20 | $124.16 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $22.41 / $34.07 / $56.84
| Professional | 26 | $22.41 | $34.07 | $56.84 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $21.45 / $34.47 / $68.31
| Professional | TC | $21.45 | $34.47 | $68.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.23 / $75.30 / $117.38
| Professional | | $53.23 | $75.30 | $117.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $25.40 / $36.84 / $56.02
| Professional | 26 | $25.40 | $36.84 | $56.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.74 / $37.76 / $62.72
| Professional | TC | $24.74 | $37.76 | $62.72 |