- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $30.90 / $158.49 / $229.09
| Facility | 26 | $30.90 | $158.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $707.95
| Professional | | $120.23 | $151.36 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $363.08 / $758.58
| Professional | | $50.12 | $363.08 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $213.80 / $870.96
| Professional | | $154.88 | $213.80 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $416.87
| Professional | | $186.21 | $218.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $36.31 / $41.69 / $77.62
| Professional | 26 | $36.31 | $41.69 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $229.09 / $616.60
| Professional | | $154.88 | $229.09 | $616.60 |