- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $33.11 / $42.66 / $58.88
| Facility | 26 | $33.11 | $42.66 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $295.12 / $446.68
| Professional | | $234.42 | $295.12 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $302.00 / $398.11
| Professional | | $269.15 | $302.00 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $707.95
| Professional | | $281.84 | $380.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $346.74 / $524.81
| Professional | | $269.15 | $346.74 | $524.81 |