- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.72 / $228.18 / $228.18
| Facility | 26 | $82.72 | $228.18 | $228.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.61 / $272.42 / $854.37
| Professional | | $183.61 | $272.42 | $854.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.81 / $297.76 / $431.75
| Professional | | $202.81 | $297.76 | $431.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.45 / $498.26 / $675.22
| Professional | | $270.45 | $498.26 | $675.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.15 / $412.63 / $935.58
| Professional | | $236.15 | $412.63 | $935.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.55 / $313.68 / $826.07
| Professional | | $289.55 | $313.68 | $826.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.15 / $202.57 / $257.81
| Professional | | $184.15 | $202.57 | $257.81 |