- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.26 / $132.60 / $303.45
| Facility | 26 | $74.26 | $132.60 | $303.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.07 / $102.43 / $270.00
| Professional | | $83.07 | $102.43 | $270.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.06 / $117.87 / $175.65
| Professional | | $75.06 | $117.87 | $175.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.76 / $149.22 / $279.58
| Professional | | $114.76 | $149.22 | $279.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.44 / $121.57 / $179.35
| Professional | | $102.44 | $121.57 | $179.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.03 / $81.22 / $96.68
| Professional | | $81.03 | $81.22 | $96.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.20 / $155.77 / $279.55
| Professional | | $95.20 | $155.77 | $279.55 |