- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $177.83 / $208.93
| Facility | 26 | $56.23 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $239.88 / $851.14
| Professional | | $158.49 | $239.88 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $478.63
| Professional | | $223.87 | $354.81 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $616.60
| Professional | | $257.04 | $323.59 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $302.00
| Professional | | $234.42 | $275.42 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $67.61 / $67.61
| Professional | | $63.10 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $323.59 / $501.19
| Professional | | $181.97 | $323.59 | $501.19 |