- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.72 / $37.66 / $69.76
| Facility | 26 | $29.72 | $37.66 | $69.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.28 / $209.65 / $315.31
| Professional | | $169.28 | $209.65 | $315.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.86 / $235.28 / $402.15
| Professional | | $184.86 | $235.28 | $402.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.11 / $35.11 / $35.11
| Facility | 26 | $35.11 | $35.11 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.10 / $286.07 / $535.09
| Professional | | $178.10 | $286.07 | $535.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.98 / $266.99 / $490.42
| Professional | | $163.98 | $266.99 | $490.42 |