- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $152.81 / $152.81 / $152.81
| Facility | 26 | $152.81 | $152.81 | $152.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.25 / $215.51 / $278.97
| Professional | | $163.25 | $215.51 | $278.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.16 / $235.40 / $357.64
| Professional | | $160.16 | $235.40 | $357.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.79 / $263.08 / $318.27
| Professional | | $187.79 | $263.08 | $318.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $65.36 / $260.70
| Professional | | $32.34 | $65.36 | $260.70 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $946.29 / $946.29 / $946.29
| Facility | 26 | $946.29 | $946.29 | $946.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.51 / $241.78 / $334.38
| Professional | | $205.51 | $241.78 | $334.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.03 / $216.00 / $292.31
| Professional | | $167.03 | $216.00 | $292.31 |