- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $61.82 / $61.82 / $102.91
| Facility | 26 | $61.82 | $61.82 | $102.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.72 / $178.78 / $297.41
| Professional | | $135.72 | $178.78 | $297.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.86 / $415.45 / $951.96
| Professional | | $284.86 | $415.45 | $951.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.45 / $255.77 / $527.30
| Professional | | $192.45 | $255.77 | $527.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.32 / $165.96 / $273.70
| Professional | | $135.32 | $165.96 | $273.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.58 / $364.50 / $710.83
| Professional | | $236.58 | $364.50 | $710.83 |