- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $114.89 / $118.86 / $132.10
| Facility | 26 | $114.89 | $118.86 | $132.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.85 / $400.42 / $519.46
| Professional | | $321.85 | $400.42 | $519.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.62 / $393.01 / $696.84
| Professional | | $270.62 | $393.01 | $696.84 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $127.80 / $127.80 / $127.80
| Facility | 26 | $127.80 | $127.80 | $127.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.81 / $520.72 / $937.64
| Professional | | $313.81 | $520.72 | $937.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.70 / $464.38 / $868.95
| Professional | | $298.70 | $464.38 | $868.95 |