- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.42 / $48.17 / $59.31
| Facility | 26 | $46.42 | $48.17 | $59.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $214.29 / $321.72
| Professional | | $154.30 | $214.29 | $321.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.71 / $242.55 / $410.41
| Professional | | $164.71 | $242.55 | $410.41 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $52.38 / $52.38 / $52.38
| Facility | 26 | $52.38 | $52.38 | $52.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.66 / $293.75 / $501.87
| Professional | | $189.66 | $293.75 | $501.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.28 / $263.05 / $423.08
| Professional | | $189.28 | $263.05 | $423.08 |