- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $158.49 / $158.49 / $162.18
| Facility | 26 | $158.49 | $158.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $645.65
| Professional | | $316.23 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $245.47 / $467.74
| Professional | | $79.43 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $812.83
| Professional | | $346.74 | $478.63 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $537.03
| Professional | | $32.36 | $33.11 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $724.44
| Professional | | $346.74 | $467.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $891.25
| Professional | | $309.03 | $501.19 | $891.25 |