- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.35 / $46.35 / $48.66
| Facility | 26 | $46.35 | $46.35 | $48.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.41 / $325.94 / $477.41
| Professional | | $289.41 | $325.94 | $477.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.41 / $360.04 / $486.05
| Professional | | $54.41 | $360.04 | $486.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.18 / $431.36 / $681.82
| Professional | | $273.18 | $431.36 | $681.82 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.28 / $46.35 / $47.18
| Facility | 26 | $32.28 | $46.35 | $47.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.55 / $315.68 / $457.98
| Professional | | $252.55 | $315.68 | $457.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.19 / $233.47 / $307.89
| Professional | | $34.19 | $233.47 | $307.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.26 / $323.36 / $430.35
| Professional | | $278.26 | $323.36 | $430.35 |