- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $60.20 / $171.56 / $436.10
| Facility | 26 | $60.20 | $171.56 | $436.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.99 / $124.71 / $153.62
| Professional | | $116.99 | $124.71 | $153.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.21 / $162.97 / $317.07
| Professional | | $145.21 | $162.97 | $317.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.51 / $180.03 / $535.98
| Professional | | $117.51 | $180.03 | $535.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.55 / $161.58 / $308.87
| Professional | | $139.55 | $161.58 | $308.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $68.48 / $79.30 / $149.99
| Professional | 26 | $68.48 | $79.30 | $149.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.43 / $180.60 / $391.38
| Professional | | $118.43 | $180.60 | $391.38 |