- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $35.28 / $46.77 / $83.06
| Facility | 26 | $35.28 | $46.77 | $83.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.85 / $180.66 / $222.15
| Professional | | $150.85 | $180.66 | $222.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.30 / $201.77 / $342.14
| Professional | | $156.30 | $201.77 | $342.14 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $41.00 / $41.00 / $41.00
| Facility | 26 | $41.00 | $41.00 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.71 / $249.60 / $402.05
| Professional | | $159.71 | $249.60 | $402.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.99 / $201.93 / $376.13
| Professional | | $152.99 | $201.93 | $376.13 |