- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $32.36 / $67.61 / $165.96
| Facility | 26 | $32.36 | $67.61 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $181.97 / $371.54
| Professional | | $138.04 | $181.97 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $199.53 / $407.38
| Professional | | $141.25 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.71 / $50.12 / $154.88
| Facility | 26 | $8.71 | $50.12 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $263.03 / $512.86
| Professional | | $141.25 | $263.03 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $199.53 / $407.38
| Professional | | $141.25 | $199.53 | $407.38 |