- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $34.35 / $34.35 / $57.90
| Facility | 26 | $34.35 | $34.35 | $57.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.24 / $258.64 / $273.83
| Professional | | $257.24 | $258.64 | $273.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $251.62 / $357.30
| Professional | | $228.40 | $251.62 | $357.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.40 / $255.20 / $321.01
| Professional | | $39.40 | $255.20 | $321.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.42 / $365.80 / $661.50
| Professional | | $284.42 | $365.80 | $661.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.23 / $338.63 / $547.88
| Professional | | $266.23 | $338.63 | $547.88 |