- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.36 / $39.24 / $39.24
| Facility | 26 | $37.36 | $39.24 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.39 / $286.42 / $286.42
| Professional | | $213.39 | $286.42 | $286.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.66 / $408.40 / $596.46
| Professional | | $301.66 | $408.40 | $596.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.48 / $397.08 / $690.21
| Professional | | $285.48 | $397.08 | $690.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.64 / $504.64 / $544.14
| Professional | | $504.64 | $504.64 | $544.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.77 / $430.99 / $548.92
| Professional | | $272.77 | $430.99 | $548.92 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $37.36 / $59.04 / $72.94
| Professional | 26 | $37.36 | $59.04 | $72.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.23 / $481.79 / $784.95
| Professional | | $272.23 | $481.79 | $784.95 |