- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $95.49 / $158.01 / $281.39
| Facility | 26 | $95.49 | $158.01 | $281.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.83 / $177.00 / $296.52
| Professional | | $146.83 | $177.00 | $296.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.51 / $175.72 / $323.14
| Professional | | $125.51 | $175.72 | $323.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.02 / $127.16 / $225.56
| Professional | | $73.02 | $127.16 | $225.56 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $102.91 / $102.91 / $102.91
| Facility | 26 | $102.91 | $102.91 | $102.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.19 / $212.04 / $346.70
| Professional | | $150.19 | $212.04 | $346.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.69 / $211.03 / $298.70
| Professional | | $144.69 | $211.03 | $298.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.97 / $109.07 / $199.27
| Professional | | $59.97 | $109.07 | $199.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.38 / $188.69 / $329.53
| Professional | | $133.38 | $188.69 | $329.53 |