- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $37.52 / $49.96 / $89.37
| Facility | 26 | $37.52 | $49.96 | $89.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.12 / $276.31 / $361.35
| Professional | | $247.12 | $276.31 | $361.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.42 / $325.17 / $551.48
| Professional | | $271.42 | $325.17 | $551.48 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $44.16 / $44.16 / $44.16
| Facility | 26 | $44.16 | $44.16 | $44.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.22 / $432.02 / $726.53
| Professional | | $306.22 | $432.02 | $726.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.88 / $345.34 / $622.82
| Professional | | $266.88 | $345.34 | $622.82 |