- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.62 / $90.23 / $169.29
| Facility | 26 | $45.62 | $90.23 | $169.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.34 / $317.24 / $1,933.63
| Professional | | $157.34 | $317.24 | $1,933.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.47 / $205.20 / $258.49
| Professional | | $150.47 | $205.20 | $258.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $91.98 / $391.62
| Professional | | $32.34 | $91.98 | $391.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.32 / $258.49 / $754.81
| Professional | | $157.32 | $258.49 | $754.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.33 / $168.90 / $330.23
| Professional | | $85.33 | $168.90 | $330.23 |