- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.80 / $46.08 / $99.54
| Facility | 26 | $19.80 | $46.08 | $99.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.91 / $203.75 / $506.33
| Professional | | $170.91 | $203.75 | $506.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $240.74 / $486.37
| Professional | | $149.63 | $240.74 | $486.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.16 / $307.83 / $561.16
| Professional | | $156.16 | $307.83 | $561.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.04 / $236.54 / $283.00
| Professional | | $215.04 | $236.54 | $283.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $21.46 / $23.61 / $37.90
| Professional | 26 | $21.46 | $23.61 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.94 / $239.35 / $417.42
| Professional | | $153.94 | $239.35 | $417.42 |