- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.13 / $245.47 / $537.03
| Facility | 26 | $74.13 | $245.47 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $123.03 / $524.81
| Professional | | $87.10 | $123.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $537.03 / $741.31
| Professional | | $95.50 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $158.49 / $630.96
| Professional | | $114.82 | $158.49 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $162.18 / $309.03
| Professional | | $141.25 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $85.11 / $97.72 / $181.97
| Professional | 26 | $85.11 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $169.82 / $457.09
| Professional | | $120.23 | $169.82 | $457.09 |