- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $141.96 / $141.96 / $147.19
| Facility | 26 | $141.96 | $141.96 | $147.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.79 / $156.74 / $371.00
| Professional | | $121.79 | $156.74 | $371.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.71 / $202.85 / $226.47
| Professional | | $165.71 | $202.85 | $226.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.19 / $204.04 / $214.78
| Professional | | $177.19 | $204.04 | $214.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $88.73 / $174.83
| Professional | | $32.34 | $88.73 | $174.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.63 / $228.79 / $267.32
| Professional | | $214.63 | $228.79 | $267.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.09 / $148.55 / $233.24
| Professional | | $122.09 | $148.55 | $233.24 |