- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.39 / $33.39 / $33.39
| Facility | 26 | $33.39 | $33.39 | $33.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.28 / $274.17 / $333.55
| Professional | | $243.28 | $274.17 | $333.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.23 / $331.23 / $380.91
| Professional | | $331.23 | $331.23 | $380.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.56 / $362.66 / $755.54
| Professional | | $216.56 | $362.66 | $755.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.68 / $331.56 / $614.00
| Professional | | $264.68 | $331.56 | $614.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.46 / $44.24 / $80.30
| Professional | 26 | $36.46 | $44.24 | $80.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.73 / $313.98 / $555.13
| Professional | | $240.73 | $313.98 | $555.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.98 / $262.17 / $397.02
| Professional | | $223.98 | $262.17 | $397.02 |