- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $54.74 / $73.89 / $73.89
| Facility | 26 | $54.74 | $73.89 | $73.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.68 / $86.84 / $106.17
| Professional | | $68.68 | $86.84 | $106.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.21 / $44.16 / $57.81
| Professional | 26 | $36.21 | $44.16 | $57.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $34.82 / $42.67 / $52.23
| Professional | TC | $34.82 | $42.67 | $52.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $70.90
| Professional | | $60.26 | $60.26 | $70.90 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.09 / $53.09 / $53.09
| Professional | 26 | $53.09 | $53.09 | $53.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.12 / $85.09 / $100.41
| Professional | | $62.12 | $85.09 | $100.41 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.70 / $44.80 / $52.86
| Professional | 26 | $32.70 | $44.80 | $52.86 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $29.41 / $40.29 / $47.54
| Professional | TC | $29.41 | $40.29 | $47.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.51 / $89.67 / $302.83
| Professional | | $67.51 | $89.67 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $41.36 / $48.66 / $166.12
| Professional | 26 | $41.36 | $48.66 | $166.12 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.83 / $41.01 / $136.72
| Professional | TC | $24.83 | $41.01 | $136.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.37 / $78.93 / $112.21
| Professional | | $59.37 | $78.93 | $112.21 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $32.59 / $44.54 / $65.81
| Professional | 26 | $32.59 | $44.54 | $65.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $25.16 / $34.97 / $50.38
| Professional | TC | $25.16 | $34.97 | $50.38 |