- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $100.68 / $243.56 / $304.43
| Facility | 26 | $100.68 | $243.56 | $304.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $144.72 / $215.44
| Professional | | $130.66 | $144.72 | $215.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.08 / $155.97 / $310.98
| Professional | | $152.08 | $155.97 | $310.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.57 / $187.24 / $279.98
| Professional | | $123.57 | $187.24 | $279.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $172.46 / $336.07 / $336.07
| Facility | 26 | $172.46 | $336.07 | $336.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.36 / $190.83 / $920.53
| Professional | | $160.36 | $190.83 | $920.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.51 / $190.83 / $293.02
| Professional | | $156.51 | $190.83 | $293.02 |