- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $82.65 / $82.66 / $113.27
| Facility | 26 | $82.65 | $82.66 | $113.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.92 / $294.49 / $464.06
| Professional | | $247.92 | $294.49 | $464.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.13 / $282.13 / $377.34
| Professional | | $282.13 | $282.13 | $377.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.36 / $353.35 / $885.89
| Professional | | $255.36 | $353.35 | $885.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $437.10 / $710.62
| Professional | | $338.84 | $437.10 | $710.62 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $98.56 / $127.14 / $205.99
| Professional | 26 | $98.56 | $127.14 | $205.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.52 / $295.51 / $525.57
| Professional | | $201.52 | $295.51 | $525.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.67 / $385.61 / $480.21
| Professional | | $207.67 | $385.61 | $480.21 |