- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $39.26 / $120.79 / $162.21
| Facility | 26 | $39.26 | $120.79 | $162.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $277.20 / $600.00
| Professional | | $192.63 | $277.20 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.99 / $327.44 / $382.13
| Professional | | $227.99 | $327.44 | $382.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.79 / $311.58 / $558.61
| Professional | | $217.79 | $311.58 | $558.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.89 / $219.23 / $254.32
| Professional | | $210.89 | $219.23 | $254.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.67 / $50.20 / $103.67
| Professional | | $49.67 | $50.20 | $103.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.76 / $352.89 / $638.08
| Professional | | $188.76 | $352.89 | $638.08 |