- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $77.34 / $115.38 / $137.16
| Facility | 26 | $77.34 | $115.38 | $137.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.41 / $258.82 / $501.27
| Professional | | $216.41 | $258.82 | $501.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.34 / $313.44 / $620.80
| Professional | | $204.34 | $313.44 | $620.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.25 / $346.81 / $557.95
| Professional | | $210.25 | $346.81 | $557.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.18 / $261.52 / $455.23
| Professional | | $201.18 | $261.52 | $455.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.06 / $94.98 / $158.22
| Professional | 26 | $73.06 | $94.98 | $158.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.28 / $188.49 / $333.96
| Professional | | $121.28 | $188.49 | $333.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.40 / $324.94 / $513.36
| Professional | | $210.40 | $324.94 | $513.36 |