- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $72.44 / $75.86
| Facility | 26 | $63.10 | $72.44 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $109.65 / $213.80
| Professional | | $60.26 | $109.65 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $186.21 / $186.21
| Professional | | $158.49 | $186.21 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $177.83
| Professional | | $89.13 | $144.54 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.10 / $69.18 / $72.44
| Facility | 26 | $63.10 | $69.18 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $186.21 / $257.04
| Professional | | $128.82 | $186.21 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $199.53 / $218.78
| Professional | | $144.54 | $199.53 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $100.00 / $223.87
| Professional | | $97.72 | $100.00 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $102.33 / $154.88
| Professional | | $64.57 | $102.33 | $154.88 |