- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $71.56 / $86.22 / $159.83
| Facility | 26 | $71.56 | $86.22 | $159.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.44 / $234.30 / $377.16
| Professional | | $186.44 | $234.30 | $377.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.05 / $262.31 / $436.59
| Professional | | $195.05 | $262.31 | $436.59 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $99.42 / $99.42 / $99.74
| Facility | 26 | $99.42 | $99.42 | $99.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.85 / $283.31 / $528.54
| Professional | | $197.85 | $283.31 | $528.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.27 / $263.39 / $423.07
| Professional | | $189.27 | $263.39 | $423.07 |