- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.30 / $69.18 / $128.18
| Facility | 26 | $65.30 | $69.18 | $128.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.29 / $115.46 / $160.08
| Professional | | $111.29 | $115.46 | $160.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.00 / $118.16 / $175.40
| Professional | | $92.00 | $118.16 | $175.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.29 / $188.29 / $188.29
| Professional | | $188.29 | $188.29 | $188.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.50 / $152.16 / $214.95
| Professional | | $91.50 | $152.16 | $214.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $132.41 / $132.41 / $251.32
| Facility | 26 | $132.41 | $132.41 | $251.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $149.00 / $759.56
| Professional | | $123.43 | $149.00 | $759.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.56 / $135.47 / $218.16
| Professional | | $122.56 | $135.47 | $218.16 |