- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.71 / $61.86 / $73.61
| Facility | 26 | $59.71 | $61.86 | $73.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.77 / $104.58 / $145.56
| Professional | | $94.77 | $104.58 | $145.56 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $47.93 / $53.95 / $75.97
| Professional | TC | $47.93 | $53.95 | $75.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.46 / $131.63 / $131.63
| Professional | | $99.46 | $131.63 | $131.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $46.78 / $61.91 / $61.91
| Professional | TC | $46.78 | $61.91 | $61.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.22 / $125.29 / $179.55
| Professional | | $77.22 | $125.29 | $179.55 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $20.91 / $63.28 / $90.75
| Professional | TC | $20.91 | $63.28 | $90.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.41 / $100.34 / $177.33
| Professional | | $73.41 | $100.34 | $177.33 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.81 / $60.48 / $85.14
| Professional | TC | $27.81 | $60.48 | $85.14 |