- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $94.36 / $94.36 / $94.36
| Facility | 26 | $94.36 | $94.36 | $94.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.22 / $480.25 / $700.21
| Professional | | $368.22 | $480.25 | $700.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.98 / $216.59 / $520.92
| Professional | | $79.98 | $216.59 | $520.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.26 / $348.03 / $896.98
| Professional | | $246.26 | $348.03 | $896.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $135.78 / $598.65
| Professional | | $32.34 | $135.78 | $598.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.15 / $423.08 / $977.37
| Professional | | $250.15 | $423.08 | $977.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.00 / $414.00 / $748.78
| Professional | | $288.00 | $414.00 | $748.78 |