- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $29.52 / $34.86 / $198.43
| Facility | 26 | $29.52 | $34.86 | $198.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.69 / $160.59 / $180.66
| Professional | | $118.69 | $160.59 | $180.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $171.85 / $235.97
| Professional | | $36.40 | $171.85 | $235.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.13 / $163.55 / $222.52
| Professional | | $144.13 | $163.55 | $222.52 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $85.52 / $168.78 / $168.78
| Facility | 26 | $85.52 | $168.78 | $168.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.99 / $189.00 / $433.86
| Professional | | $152.99 | $189.00 | $433.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.99 / $172.14 / $286.91
| Professional | | $152.99 | $172.14 | $286.91 |