- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $27.37 / $29.07 / $32.12
| Facility | 26 | $27.37 | $29.07 | $32.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $159.36 / $199.25
| Professional | | $127.04 | $159.36 | $199.25 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.16 / $130.47 / $169.43
| Professional | TC | $103.16 | $130.47 | $169.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.63 / $148.81 / $302.76
| Professional | | $103.63 | $148.81 | $302.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $82.74 / $122.85 / $247.97
| Professional | TC | $82.74 | $122.85 | $247.97 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.71 / $30.71 / $30.71
| Facility | 26 | $30.71 | $30.71 | $30.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.84 / $195.21 / $354.76
| Professional | | $102.84 | $195.21 | $354.76 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $93.47 / $168.87 / $294.30
| Professional | TC | $93.47 | $168.87 | $294.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.92 / $165.85 / $303.36
| Professional | | $106.92 | $165.85 | $303.36 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $80.66 / $133.40 / $241.58
| Professional | TC | $80.66 | $133.40 | $241.58 |