- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.42 / $110.53 / $143.41
| Facility | 26 | $36.42 | $110.53 | $143.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.44 / $223.21 / $546.38
| Professional | | $157.44 | $223.21 | $546.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.47 / $317.76 / $354.07
| Professional | | $204.47 | $317.76 | $354.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.58 / $316.54 / $539.57
| Professional | | $211.58 | $316.54 | $539.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.63 / $206.09 / $268.32
| Professional | | $185.63 | $206.09 | $268.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.91 / $386.41 / $726.38
| Professional | | $191.91 | $386.41 | $726.38 |