- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $55.40 / $158.56 / $158.56
| Facility | 26 | $55.40 | $158.56 | $158.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.82 / $296.87 / $963.18
| Professional | | $269.82 | $296.87 | $963.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.86 / $391.79 / $568.09
| Professional | | $266.86 | $391.79 | $568.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.11 / $674.06 / $954.02
| Professional | | $357.11 | $674.06 | $954.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.72 / $542.92 / $3,253.80
| Professional | | $310.72 | $542.92 | $3,253.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.81 / $401.33 / $577.41
| Professional | | $305.81 | $401.33 | $577.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.50 / $303.58 / $452.47
| Professional | | $256.50 | $303.58 | $452.47 |