- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.24 / $34.85 / $42.98
| Facility | 26 | $34.24 | $34.85 | $42.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.77 / $167.95 / $199.48
| Professional | | $132.77 | $167.95 | $199.48 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.95 / $138.44 / $169.43
| Professional | TC | $103.95 | $138.44 | $169.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.94 / $177.28 / $177.28
| Professional | | $133.94 | $177.28 | $177.28 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $104.01 / $137.66 / $137.66
| Professional | TC | $104.01 | $137.66 | $137.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.03 / $178.86 / $297.92
| Professional | | $100.03 | $178.86 | $297.92 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $50.41 / $143.30 / $236.48
| Professional | TC | $50.41 | $143.30 | $236.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.66 / $135.34 / $252.15
| Professional | | $88.66 | $135.34 | $252.15 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $63.00 / $117.35 / $196.32
| Professional | TC | $63.00 | $117.35 | $196.32 |