- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $104.71 / $331.13 / $398.11
| Facility | 26 | $104.71 | $331.13 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $151.36 / $524.81
| Professional | | $104.71 | $151.36 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $309.03
| Professional | | $147.91 | $190.55 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $245.47 / $331.13
| Professional | | $169.82 | $245.47 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $234.42
| Professional | | $134.90 | $186.21 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $120.23 / $128.82
| Professional | | $117.49 | $120.23 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $199.53 / $323.59
| Professional | | $128.82 | $199.53 | $323.59 |