- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $65.12 / $65.13 / $335.50
| Facility | 26 | $65.12 | $65.13 | $335.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.37 / $242.17 / $508.74
| Professional | | $174.37 | $242.17 | $508.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.19 / $85.19 / $195.82
| Professional | | $85.19 | $85.19 | $195.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.88 / $333.16 / $587.85
| Professional | | $186.88 | $333.16 | $587.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.25 / $307.16 / $762.20
| Professional | | $219.25 | $307.16 | $762.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.46 / $268.27 / $467.55
| Professional | | $218.46 | $268.27 | $467.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $278.25 / $493.68
| Professional | | $154.30 | $278.25 | $493.68 |