- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $48.91 / $229.67 / $442.02
| Facility | 26 | $48.91 | $229.67 | $442.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.18 / $106.18 / $256.95
| Professional | | $106.18 | $106.18 | $256.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.38 / $134.38 / $607.85
| Professional | | $134.38 | $134.38 | $607.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.20 / $155.34 / $542.26
| Professional | | $98.20 | $155.34 | $542.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.61 / $258.38 / $258.38
| Professional | | $116.61 | $258.38 | $258.38 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $55.08 / $120.46 / $120.46
| Professional | 26 | $55.08 | $120.46 | $120.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.15 / $172.73 / $327.39
| Professional | | $115.15 | $172.73 | $327.39 |