- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $72.19 / $159.66 / $371.50
| Facility | 26 | $72.19 | $159.66 | $371.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.03 / $128.37 / $355.46
| Professional | | $105.03 | $128.37 | $355.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.65 / $179.66 / $366.92
| Professional | | $124.65 | $179.66 | $366.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.60 / $249.96 / $407.89
| Professional | | $139.60 | $249.96 | $407.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $229.44 / $526.65
| Professional | | $143.91 | $229.44 | $526.65 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $88.85 / $141.63 / $161.54
| Professional | 26 | $88.85 | $141.63 | $161.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.59 / $183.70 / $346.03
| Professional | | $130.59 | $183.70 | $346.03 |