- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.48 / $135.80 / $182.49
| Facility | 26 | $44.48 | $135.80 | $182.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.71 / $355.21 / $778.01
| Professional | | $254.71 | $355.21 | $778.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.89 / $528.30 / $680.03
| Professional | | $275.89 | $528.30 | $680.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.14 / $458.87 / $719.18
| Professional | | $383.14 | $458.87 | $719.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.02 / $315.77 / $432.99
| Professional | | $299.02 | $315.77 | $432.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $126.00 / $126.00
| Professional | | $126.00 | $126.00 | $126.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.20 / $453.90 / $814.16
| Professional | | $272.20 | $453.90 | $814.16 |