- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.61 / $36.61 / $58.84
| Facility | 26 | $36.61 | $36.61 | $58.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $233.03 / $243.21
| Professional | | $192.63 | $233.03 | $243.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.11 / $494.30 / $543.75
| Professional | | $411.11 | $494.30 | $543.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.60 / $351.24 / $539.03
| Professional | | $242.60 | $351.24 | $539.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.33 / $468.91 / $1,447.02
| Professional | | $244.33 | $468.91 | $1,447.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.64 / $449.48 / $612.82
| Professional | | $259.64 | $449.48 | $612.82 |