- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.36 / $94.81 / $124.24
| Facility | 26 | $31.36 | $94.81 | $124.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.67 / $84.56 / $355.00
| Professional | | $59.67 | $84.56 | $355.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.15 / $99.84 / $129.72
| Professional | | $70.15 | $99.84 | $129.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.54 / $124.48 / $177.42
| Professional | | $82.54 | $124.48 | $177.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.26 / $82.56 / $128.94
| Professional | | $71.26 | $82.56 | $128.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.06 / $54.07 / $125.19
| Professional | | $44.06 | $54.07 | $125.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.09 / $99.97 / $177.72
| Professional | | $65.09 | $99.97 | $177.72 |