- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.23 / $175.98 / $228.68
| Facility | 26 | $59.23 | $175.98 | $228.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.37 / $144.44 / $592.00
| Professional | | $98.37 | $144.44 | $592.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.28 / $180.84 / $228.85
| Professional | | $117.28 | $180.84 | $228.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.33 / $179.68 / $285.48
| Professional | | $134.33 | $179.68 | $285.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.60 / $143.21 / $179.04
| Professional | | $122.60 | $143.21 | $179.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.52 / $186.54 / $273.00
| Professional | | $79.52 | $186.54 | $273.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.43 / $169.70 / $285.10
| Professional | | $104.43 | $169.70 | $285.10 |