- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $28.14 / $33.21 / $190.73
| Facility | 26 | $28.14 | $33.21 | $190.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.15 / $199.63 / $225.97
| Professional | | $150.15 | $199.63 | $225.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.49 / $217.35 / $298.45
| Professional | | $36.49 | $217.35 | $298.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.38 / $196.26 / $289.61
| Professional | | $163.38 | $196.26 | $289.61 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $81.73 / $155.94 / $155.94
| Facility | 26 | $81.73 | $155.94 | $155.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $232.11 / $546.02
| Professional | | $169.75 | $232.11 | $546.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.75 / $212.57 / $450.65
| Professional | | $169.75 | $212.57 | $450.65 |