- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $40.06 / $49.79 / $79.18
| Facility | 26 | $40.06 | $49.79 | $79.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.63 / $208.30 / $251.78
| Professional | | $192.63 | $208.30 | $251.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.44 / $328.44 / $328.44
| Professional | | $328.44 | $328.44 | $328.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.21 / $234.45 / $391.52
| Professional | | $60.21 | $234.45 | $391.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.73 / $81.73 / $81.73
| Facility | 26 | $81.73 | $81.73 | $81.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.77 / $259.64 / $1,447.02
| Professional | | $184.77 | $259.64 | $1,447.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.52 / $247.66 / $390.93
| Professional | | $180.52 | $247.66 | $390.93 |