- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.91 / $56.40 / $87.47
| Facility | 26 | $44.91 | $56.40 | $87.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.70 / $298.50 / $337.73
| Professional | | $224.70 | $298.50 | $337.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.34 / $325.85 / $447.44
| Professional | | $59.34 | $325.85 | $447.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.94 / $312.95 / $432.41
| Professional | | $266.94 | $312.95 | $432.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $131.08 / $252.03 / $252.03
| Facility | 26 | $131.08 | $252.03 | $252.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $347.99 / $814.10
| Professional | | $255.10 | $347.99 | $814.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.10 / $330.75 / $549.47
| Professional | | $255.10 | $330.75 | $549.47 |