- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.76 / $39.57 / $218.49
| Facility | 26 | $31.76 | $39.57 | $218.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.47 / $253.33 / $289.77
| Professional | | $192.47 | $253.33 | $289.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.02 / $278.95 / $383.04
| Professional | | $42.02 | $278.95 | $383.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.97 / $267.55 / $407.10
| Professional | | $229.97 | $267.55 | $407.10 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $91.64 / $172.60 / $172.60
| Facility | 26 | $91.64 | $172.60 | $172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.60 / $313.98 / $616.34
| Professional | | $260.60 | $313.98 | $616.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.18 / $298.27 / $470.97
| Professional | | $251.18 | $298.27 | $470.97 |