- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $26.01 / $48.12 / $55.09
| Facility | 26 | $26.01 | $48.12 | $55.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.16 / $237.41 / $1,402.11
| Professional | | $166.16 | $237.41 | $1,402.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.35 / $147.02 / $321.11
| Professional | | $32.35 | $147.02 | $321.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.61 / $284.16 / $399.84
| Professional | | $215.61 | $284.16 | $399.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $53.46 / $310.61
| Professional | | $32.34 | $53.46 | $310.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.88 / $314.60 / $399.84
| Professional | | $189.88 | $314.60 | $399.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $207.68 / $476.44
| Professional | | $169.75 | $207.68 | $476.44 |