- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $93.80 / $161.49 / $205.98
| Facility | 26 | $93.80 | $161.49 | $205.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.45 / $251.87 / $506.87
| Professional | | $165.45 | $251.87 | $506.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.08 / $316.00 / $316.00
| Professional | | $92.08 | $316.00 | $316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.44 / $281.92 / $387.73
| Professional | | $186.44 | $281.92 | $387.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.99 / $240.00 / $410.67
| Professional | | $159.99 | $240.00 | $410.67 |