- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $51.52 / $51.52 / $86.58
| Facility | 26 | $51.52 | $51.52 | $86.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.57 / $296.02 / $320.67
| Professional | | $294.57 | $296.02 | $320.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.72 / $231.69 / $307.74
| Professional | | $216.72 | $231.69 | $307.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.79 / $269.10 / $356.55
| Professional | | $53.79 | $269.10 | $356.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.54 / $343.02 / $677.41
| Professional | | $240.54 | $343.02 | $677.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.41 / $363.28 / $622.73
| Professional | | $274.41 | $363.28 | $622.73 |