- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $38.27 / $87.67 / $197.64
| Facility | 26 | $38.27 | $87.67 | $197.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.11 / $210.36 / $496.78
| Professional | | $172.11 | $210.36 | $496.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.81 / $282.89 / $502.19
| Professional | | $195.81 | $282.89 | $502.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.66 / $389.88 / $594.69
| Professional | | $212.66 | $389.88 | $594.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.45 / $361.00 / $591.01
| Professional | | $226.45 | $361.00 | $591.01 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.76 / $74.55 / $133.00
| Professional | 26 | $46.76 | $74.55 | $133.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.19 / $251.51 / $487.94
| Professional | | $64.19 | $251.51 | $487.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.02 / $296.58 / $529.11
| Professional | | $208.02 | $296.58 | $529.11 |