- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $31.89 / $157.01 / $296.58
| Facility | 26 | $31.89 | $157.01 | $296.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.08 / $169.81 / $169.81
| Professional | | $156.08 | $169.81 | $169.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.03 / $220.21 / $538.24
| Professional | | $202.03 | $220.21 | $538.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.16 / $212.48 / $874.38
| Professional | | $155.16 | $212.48 | $874.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.25 / $412.96 / $412.96
| Professional | | $184.25 | $412.96 | $412.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.94 / $78.31 / $78.31
| Professional | 26 | $35.94 | $78.31 | $78.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.44 / $207.96 / $617.75
| Professional | | $154.44 | $207.96 | $617.75 |