- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $158.49 / $478.63
| Facility | 26 | $66.07 | $158.49 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $144.54 / $229.09
| Professional | | $107.15 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $398.11 / $616.60
| Professional | | $87.10 | $398.11 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $151.36 / $676.08
| Professional | | $123.03 | $151.36 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $190.55 / $346.74
| Professional | | $162.18 | $190.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $77.62 / $89.13 / $162.18
| Professional | 26 | $77.62 | $89.13 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $181.97 / $489.78
| Professional | | $117.49 | $181.97 | $489.78 |