- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $46.85 / $219.63 / $425.40
| Facility | 26 | $46.85 | $219.63 | $425.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.99 / $107.74 / $207.31
| Professional | | $100.99 | $107.74 | $207.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.36 / $154.26 / $1,148.99
| Professional | | $147.36 | $154.26 | $1,148.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.41 / $320.77 / $635.74
| Professional | | $101.41 | $320.77 | $635.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.42 / $139.44 / $265.19
| Professional | | $120.42 | $139.44 | $265.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $53.40 / $61.83 / $115.99
| Professional | 26 | $53.40 | $61.83 | $115.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.43 / $248.66 / $353.78
| Professional | | $138.43 | $248.66 | $353.78 |