- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.23 / $290.58 / $393.65
| Facility | 26 | $94.23 | $290.58 | $393.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.29 / $150.27 / $442.27
| Professional | | $126.29 | $150.27 | $442.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.53 / $192.69 / $232.25
| Professional | | $139.53 | $192.69 | $232.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.93 / $243.68 / $343.36
| Professional | | $173.93 | $243.68 | $343.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.09 / $193.98 / $234.82
| Professional | | $136.09 | $193.98 | $234.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.03 / $127.79 / $260.27
| Professional | | $117.03 | $127.79 | $260.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.18 / $235.70 / $404.34
| Professional | | $132.18 | $235.70 | $404.34 |