- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $56.23 / $109.65 / $138.04
| Facility | 26 | $56.23 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $107.15 / $549.54
| Professional | | $64.57 | $107.15 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Professional | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $125.89 / $234.42
| Professional | | $107.15 | $125.89 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $97.72 / $165.96
| Professional | | $61.66 | $97.72 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $66.07 / $66.07 / $125.89
| Facility | 26 | $66.07 | $66.07 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $95.50 / $676.08
| Professional | | $58.88 | $95.50 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $87.10 / $123.03
| Professional | | $58.88 | $87.10 | $123.03 |