- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $50.57 / $122.37 / $398.05
| Facility | 26 | $50.57 | $122.37 | $398.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.05 / $251.44 / $251.44
| Professional | | $217.05 | $251.44 | $251.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.91 / $279.91 / $734.59
| Professional | | $279.91 | $279.91 | $734.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.02 / $187.02 / $1,159.26
| Professional | | $82.02 | $187.02 | $1,159.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.22 / $645.95 / $645.95
| Professional | | $350.22 | $645.95 | $645.95 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.13 / $132.21 / $132.21
| Professional | 26 | $73.13 | $132.21 | $132.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.63 / $201.65 / $681.92
| Professional | | $106.63 | $201.65 | $681.92 |