- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $90.76 / $274.11 / $359.21
| Facility | 26 | $90.76 | $274.11 | $359.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.77 / $311.87 / $1,220.00
| Professional | | $215.77 | $311.87 | $1,220.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.06 / $349.70 / $460.96
| Professional | | $246.06 | $349.70 | $460.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.39 / $374.88 / $645.82
| Professional | | $195.39 | $374.88 | $645.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.86 / $249.36 / $355.78
| Professional | | $211.86 | $249.36 | $355.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.73 / $155.44 / $455.63
| Professional | | $125.73 | $155.44 | $455.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.33 / $373.44 / $665.21
| Professional | | $216.33 | $373.44 | $665.21 |