- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $53.53 / $69.94 / $115.70
| Facility | 26 | $53.53 | $69.94 | $115.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.47 / $320.67 / $548.37
| Professional | | $286.47 | $320.67 | $548.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.87 / $370.76 / $590.92
| Professional | | $281.87 | $370.76 | $590.92 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $63.43 / $63.43 / $63.43
| Facility | 26 | $63.43 | $63.43 | $63.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.97 / $464.20 / $779.39
| Professional | | $278.97 | $464.20 | $779.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.33 / $384.71 / $710.76
| Professional | | $273.33 | $384.71 | $710.76 |