- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.50 / $74.45 / $122.52
| Facility | 26 | $45.50 | $74.45 | $122.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.74 / $236.86 / $267.82
| Professional | | $202.74 | $236.86 | $267.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.78 / $259.01 / $444.56
| Professional | | $210.78 | $259.01 | $444.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.73 / $312.58 / $530.74
| Professional | | $219.73 | $312.58 | $530.74 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $129.58 / $252.81 / $252.81
| Facility | 26 | $129.58 | $252.81 | $252.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.74 / $286.86 / $1,574.10
| Professional | | $218.74 | $286.86 | $1,574.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.74 / $284.20 / $491.58
| Professional | | $218.74 | $284.20 | $491.58 |