- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $19.68 / $26.19 / $46.24
| Facility | 26 | $19.68 | $26.19 | $46.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.90 / $182.64 / $299.43
| Professional | | $154.90 | $182.64 | $299.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.65 / $199.60 / $328.38
| Professional | | $153.65 | $199.60 | $328.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $22.86 / $22.86 / $22.86
| Facility | 26 | $22.86 | $22.86 | $22.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.44 / $245.09 / $411.20
| Professional | | $148.44 | $245.09 | $411.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.65 / $202.01 / $385.78
| Professional | | $141.65 | $202.01 | $385.78 |