- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.14 / $154.88 / $206.13
| Facility | 26 | $107.14 | $154.88 | $206.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.18 / $358.84 / $500.16
| Professional | | $267.18 | $358.84 | $500.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.58 / $380.23 / $570.45
| Professional | | $288.58 | $380.23 | $570.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.69 / $167.70 / $347.69
| Professional | | $117.69 | $167.70 | $347.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | 26 | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.98 / $521.51 / $905.30
| Professional | | $330.98 | $521.51 | $905.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $322.32
| Professional | | $32.34 | $32.34 | $322.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.39 / $413.76 / $582.33
| Professional | | $300.39 | $413.76 | $582.33 |