- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.36 / $29.36 / $62.06
| Facility | 26 | $29.36 | $29.36 | $62.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.39 / $340.79 / $1,802.44
| Professional | | $213.39 | $340.79 | $1,802.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.10 / $186.49 / $469.27
| Professional | | $36.10 | $186.49 | $469.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $402.46 / $535.45
| Professional | | $352.43 | $402.46 | $535.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $59.12 / $390.96
| Professional | | $32.34 | $59.12 | $390.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.43 / $445.58 / $535.45
| Professional | | $352.43 | $445.58 | $535.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.88 / $286.02 / $756.90
| Professional | | $266.88 | $286.02 | $756.90 |