- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $59.50 / $76.65 / $418.08
| Facility | 26 | $59.50 | $76.65 | $418.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.51 / $138.21 / $152.04
| Professional | | $94.51 | $138.21 | $152.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.13 / $137.49 / $216.22
| Professional | | $83.13 | $137.49 | $216.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.82 / $133.91 / $206.17
| Professional | | $119.82 | $133.91 | $206.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.46 / $336.07 / $336.07
| Facility | 26 | $172.46 | $336.07 | $336.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.85 / $168.49 / $317.52
| Professional | | $128.85 | $168.49 | $317.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.13 / $161.94 / $231.97
| Professional | | $122.13 | $161.94 | $231.97 |