- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.85 / $138.32 / $171.46
| Facility | 26 | $44.85 | $138.32 | $171.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.82 / $375.96 / $926.96
| Professional | | $269.82 | $375.96 | $926.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.01 / $474.84 / $563.38
| Professional | | $300.01 | $474.84 | $563.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.89 / $445.18 / $756.17
| Professional | | $330.89 | $445.18 | $756.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.63 / $325.19 / $391.13
| Professional | | $322.63 | $325.19 | $391.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.14 / $111.14 / $111.14
| Professional | | $111.14 | $111.14 | $111.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.06 / $434.94 / $756.97
| Professional | | $213.06 | $434.94 | $756.97 |