- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $124.16 / $214.58 / $493.00
| Facility | 26 | $124.16 | $214.58 | $493.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.00 / $153.19 / $248.33
| Professional | | $129.00 | $153.19 | $248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.76 / $197.74 / $286.99
| Professional | | $118.76 | $197.74 | $286.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.35 / $236.40 / $460.47
| Professional | | $192.35 | $236.40 | $460.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.43 / $202.42 / $298.44
| Professional | | $170.43 | $202.42 | $298.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.55 / $244.14 / $477.14
| Professional | | $153.55 | $244.14 | $477.14 |