- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $58.88 / $75.86 / $416.87
| Facility | 26 | $58.88 | $75.86 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $138.04 / $158.49
| Professional | | $109.65 | $138.04 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $138.04 / $229.09
| Professional | | $70.79 | $138.04 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $141.25 / $213.80
| Professional | | $125.89 | $141.25 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $173.78 / $338.84 / $338.84
| Facility | 26 | $173.78 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $169.82 / $295.12
| Professional | | $123.03 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $158.49 / $229.09
| Professional | | $123.03 | $158.49 | $229.09 |