- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.23 / $79.20 / $79.20
| Facility | 26 | $30.23 | $79.20 | $79.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.50 / $188.93 / $526.58
| Professional | | $156.50 | $188.93 | $526.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $249.32 / $361.51
| Professional | | $169.82 | $249.32 | $361.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.30 / $418.22 / $549.89
| Professional | | $227.30 | $418.22 | $549.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.73 / $345.51 / $3,253.80
| Professional | | $197.73 | $345.51 | $3,253.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.34 / $254.00 / $525.05
| Professional | | $138.34 | $254.00 | $525.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.85 / $183.20 / $276.68
| Professional | | $156.85 | $183.20 | $276.68 |