- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.62 / $29.62 / $62.60
| Facility | 26 | $29.62 | $29.62 | $62.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.24 / $324.99 / $1,008.00
| Professional | | $220.24 | $324.99 | $1,008.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.13 / $192.31 / $329.68
| Professional | | $36.13 | $192.31 | $329.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.77 / $425.06 / $571.99
| Professional | | $323.77 | $425.06 | $571.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $59.64 / $406.33
| Professional | | $32.34 | $59.64 | $406.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.45 / $470.60 / $571.99
| Professional | | $284.45 | $470.60 | $571.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $271.61 / $630.54
| Professional | | $255.10 | $271.61 | $630.54 |