- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.19 / $15.19 / $32.09
| Facility | 26 | $15.19 | $15.19 | $32.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.03 / $214.07 / $1,130.11
| Professional | | $134.03 | $214.07 | $1,130.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.72 / $108.44 / $234.30
| Professional | | $18.72 | $108.44 | $234.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.64 / $247.87 / $333.73
| Professional | | $167.64 | $247.87 | $333.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.98 / $32.34 / $254.31
| Professional | | $23.98 | $32.34 | $254.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.47 / $274.42 / $333.73
| Professional | | $145.47 | $274.42 | $333.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.06 / $157.97 / $384.25
| Professional | | $132.06 | $157.97 | $384.25 |