- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Facility | 26 | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.04 / $157.69 / $197.49
| Professional | | $127.04 | $157.69 | $197.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $103.46 / $131.38 / $159.74
| Professional | TC | $103.46 | $131.38 | $159.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.59 / $177.17 / $230.63
| Professional | | $150.59 | $177.17 | $230.63 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $105.46 / $149.78 / $150.65
| Professional | TC | $105.46 | $149.78 | $150.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.06 / $153.72 / $324.61
| Professional | | $81.06 | $153.72 | $324.61 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $124.37 / $207.11 / $294.30
| Professional | TC | $124.37 | $207.11 | $294.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.73 / $169.64 / $226.19
| Professional | | $71.73 | $169.64 | $226.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $41.78 / $118.39 / $183.91
| Professional | TC | $41.78 | $118.39 | $183.91 |