- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $45.17 / $54.81 / $90.18
| Facility | 26 | $45.17 | $54.81 | $90.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.95 / $282.04 / $330.88
| Professional | | $269.95 | $282.04 | $330.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.54 / $436.54 / $436.54
| Professional | | $436.54 | $436.54 | $436.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $319.38 / $518.95
| Professional | | $70.31 | $319.38 | $518.95 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $92.50 / $92.50 / $92.50
| Facility | 26 | $92.50 | $92.50 | $92.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.41 / $355.70 / $1,919.16
| Professional | | $277.41 | $355.70 | $1,919.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.35 / $323.36 / $517.38
| Professional | | $269.35 | $323.36 | $517.38 |