- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.77 / $60.26 / $83.18
| Facility | 26 | $46.77 | $60.26 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $323.59 / $489.78
| Professional | | $269.15 | $323.59 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $239.88
| Professional | | $234.42 | $234.42 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $302.00 / $407.38
| Professional | | $229.09 | $302.00 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $416.87 / $776.25
| Professional | | $239.88 | $416.87 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $575.44
| Professional | | $281.84 | $363.08 | $575.44 |