- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.93 / $66.58 / $82.14
| Facility | 26 | $59.93 | $66.58 | $82.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.13 / $203.59 / $522.50
| Professional | | $182.13 | $203.59 | $522.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.97 / $182.97 / $250.75
| Professional | | $182.97 | $182.97 | $250.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.79 / $101.49 / $280.64
| Professional | | $72.79 | $101.49 | $280.64 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $78.34 / $78.34 / $78.34
| Facility | 26 | $78.34 | $78.34 | $78.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.95 / $346.11 / $520.32
| Professional | | $201.95 | $346.11 | $520.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $195.82
| Professional | | $32.34 | $32.34 | $195.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.65 / $344.28 / $831.34
| Professional | | $216.65 | $344.28 | $831.34 |