- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.84 / $227.70 / $440.69
| Facility | 26 | $46.84 | $227.70 | $440.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.54 / $113.99 / $275.85
| Professional | | $106.54 | $113.99 | $275.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.90 / $164.06 / $1,208.16
| Professional | | $156.90 | $164.06 | $1,208.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.28 / $339.37 / $636.27
| Professional | | $107.28 | $339.37 | $636.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.40 / $147.51 / $281.35
| Professional | | $127.40 | $147.51 | $281.35 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.06 / $61.44 / $116.03
| Professional | 26 | $53.06 | $61.44 | $116.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.44 / $185.82 / $368.00
| Professional | | $132.44 | $185.82 | $368.00 |