- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.17 / $184.28 / $239.06
| Facility | 26 | $60.17 | $184.28 | $239.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.75 / $152.54 / $351.52
| Professional | | $107.75 | $152.54 | $351.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.35 / $298.33 / $423.64
| Professional | | $120.35 | $298.33 | $423.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $339.43 / $763.36
| Professional | | $155.00 | $339.43 | $763.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.44 / $287.81 / $685.72
| Professional | | $140.44 | $287.81 | $685.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.52 / $192.39 / $422.24
| Professional | | $126.52 | $192.39 | $422.24 |