- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $36.29 / $36.29 / $46.13
| Facility | 26 | $36.29 | $36.29 | $46.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.33 / $259.19 / $324.99
| Professional | | $258.33 | $259.19 | $324.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.71 / $248.57 / $352.96
| Professional | | $223.71 | $248.57 | $352.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.49 / $258.07 / $326.43
| Professional | | $41.49 | $258.07 | $326.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.74 / $360.88 / $635.63
| Professional | | $279.74 | $360.88 | $635.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.37 / $323.36 / $527.11
| Professional | | $268.37 | $323.36 | $527.11 |