- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.32 / $36.32 / $76.55
| Facility | 26 | $36.32 | $36.32 | $76.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.20 / $409.60 / $491.94
| Professional | | $308.20 | $409.60 | $491.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.78 / $142.83 / $462.58
| Professional | | $34.78 | $142.83 | $462.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.09 / $564.66 / $758.83
| Professional | | $357.09 | $564.66 | $758.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $59.61 / $501.60
| Professional | | $32.34 | $59.61 | $501.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.52 / $702.77 / $977.66
| Professional | | $400.52 | $702.77 | $977.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.62 / $444.50 / $1,020.18
| Professional | | $377.62 | $444.50 | $1,020.18 |