- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.12 / $186.92 / $242.56
| Facility | 26 | $60.12 | $186.92 | $242.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $158.88 / $805.86
| Professional | | $111.23 | $158.88 | $805.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.91 / $298.33 / $423.64
| Professional | | $125.91 | $298.33 | $423.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.52 / $341.75 / $762.43
| Professional | | $164.52 | $341.75 | $762.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.41 / $301.37 / $684.90
| Professional | | $147.41 | $301.37 | $684.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.01 / $105.68 / $345.69
| Professional | | $77.01 | $105.68 | $345.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.46 / $223.16 / $442.60
| Professional | | $137.46 | $223.16 | $442.60 |