- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.77 / $120.98 / $157.80
| Facility | 26 | $39.77 | $120.98 | $157.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.12 / $168.23 / $579.00
| Professional | | $106.12 | $168.23 | $579.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.38 / $170.66 / $217.83
| Professional | | $114.38 | $170.66 | $217.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.93 / $179.25 / $287.35
| Professional | | $121.93 | $179.25 | $287.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.16 / $143.63 / $182.01
| Professional | | $123.16 | $143.63 | $182.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.80 / $182.88 / $274.62
| Professional | | $54.80 | $182.88 | $274.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.57 / $159.78 / $289.93
| Professional | | $100.57 | $159.78 | $289.93 |