- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $107.15 / $112.20 / $162.18
| Facility | 26 | $107.15 | $112.20 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $346.74
| Professional | | $144.54 | $181.97 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $194.98 / $295.12
| Professional | | $154.88 | $194.98 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $281.84
| Professional | | $165.96 | $194.98 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $354.81
| Professional | | $162.18 | $218.78 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $213.80 / $416.87 / $416.87
| Facility | 26 | $213.80 | $416.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $1,318.26
| Professional | | $158.49 | $263.03 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $346.74
| Professional | | $144.54 | $218.78 | $346.74 |