- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.18 / $49.54 / $49.54
| Facility | 26 | $47.18 | $49.54 | $49.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.20 / $414.55 / $471.10
| Professional | | $308.20 | $414.55 | $471.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.33 / $614.00 / $877.07
| Professional | | $447.33 | $614.00 | $877.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.24 / $559.99 / $1,044.97
| Professional | | $384.24 | $559.99 | $1,044.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.59 / $745.59 / $805.06
| Professional | | $745.59 | $745.59 | $805.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.92 / $652.89 / $886.64
| Professional | | $523.92 | $652.89 | $886.64 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.33 / $76.43 / $103.80
| Professional | 26 | $61.33 | $76.43 | $103.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.06 / $750.91 / $1,252.26
| Professional | | $423.06 | $750.91 | $1,252.26 |