- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.79 / $64.98 / $71.93
| Facility | 26 | $35.79 | $64.98 | $71.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $162.83 / $291.83
| Professional | | $145.22 | $162.83 | $291.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.50 / $321.50 / $321.50
| Professional | | $321.50 | $321.50 | $321.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.00 / $153.00 / $153.00
| Professional | | $153.00 | $153.00 | $153.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.41 / $204.45 / $276.10
| Professional | | $139.41 | $204.45 | $276.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $90.59
| Professional | | $32.34 | $32.34 | $90.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.50 / $163.12 / $375.73
| Professional | | $130.50 | $163.12 | $375.73 |