- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $88.82 / $386.88 / $637.63
| Facility | 26 | $88.82 | $386.88 | $637.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.02 / $244.82 / $251.87
| Professional | | $172.02 | $244.82 | $251.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.53 / $269.79 / $445.15
| Professional | | $219.53 | $269.79 | $445.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.34 / $253.17 / $846.91
| Professional | | $177.34 | $253.17 | $846.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.88 / $291.45 / $597.57
| Professional | | $276.88 | $291.45 | $597.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $101.43 / $106.77 / $219.31
| Professional | 26 | $101.43 | $106.77 | $219.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.95 / $236.90 / $757.20
| Professional | | $165.95 | $236.90 | $757.20 |