- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.26 / $46.48 / $46.48
| Facility | 26 | $44.26 | $46.48 | $46.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.09 / $364.18 / $414.55
| Professional | | $248.09 | $364.18 | $414.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.97 / $540.45 / $772.01
| Professional | | $387.97 | $540.45 | $772.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.76 / $492.81 / $876.19
| Professional | | $337.76 | $492.81 | $876.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.82 / $662.82 / $715.54
| Professional | | $662.82 | $662.82 | $715.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.76 / $580.41 / $788.22
| Professional | | $465.76 | $580.41 | $788.22 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $57.54 / $71.70 / $97.37
| Professional | 26 | $57.54 | $71.70 | $97.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.53 / $650.19 / $990.45
| Professional | | $356.53 | $650.19 | $990.45 |