- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.47 / $118.71 / $152.09
| Facility | 26 | $39.47 | $118.71 | $152.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.59 / $135.87 / $538.00
| Professional | | $76.59 | $135.87 | $538.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.08 / $147.13 / $209.48
| Professional | | $82.08 | $147.13 | $209.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.91 / $139.91 / $218.42
| Professional | | $105.91 | $139.91 | $218.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.69 / $115.14 / $152.38
| Professional | | $98.69 | $115.14 | $152.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.49 / $106.39 / $143.46
| Professional | | $57.49 | $106.39 | $143.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.23 / $122.45 / $219.04
| Professional | | $80.23 | $122.45 | $219.04 |