- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $74.61 / $74.61 / $157.44
| Facility | 26 | $74.61 | $74.61 | $157.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.52 / $425.85 / $607.01
| Professional | | $264.52 | $425.85 | $607.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.19 / $236.49 / $396.20
| Professional | | $71.19 | $236.49 | $396.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.04 / $481.19 / $678.32
| Professional | | $323.04 | $481.19 | $678.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $123.24 / $400.01
| Professional | | $32.34 | $123.24 | $400.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.05 / $594.77 / $847.82
| Professional | | $363.05 | $594.77 | $847.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.29 / $731.38 / $1,418.38
| Professional | | $335.29 | $731.38 | $1,418.38 |